Our Lady of the Lake Regional Medica

Primary specialty

Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X

Legal business name

OUR LADY OF THE LAKE REGIONAL MEDICA

Doing business as

Our Lady Of The Lake Hospital Inc Pediatric Pulmonary Clinic

Practice address

7777 Hennessy Blvd
Plaza 1 Suite 406
Baton Rouge, LA 70810

Phone

(225) 765-3456

Fax

(225) 765-1899

NPI assigned

Feb 13, 2007

Last updated

May 19, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tamara White

Title

Director of Business Services

Phone

(225) 765-4251

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Our Lady Of The Lake Hospital Inc Pediatric Pulmonary Clinic Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Franciscan Missionaries of Our Lady Health System Inc

  dba RxONE St Dominic

  • Pharmacy
  • Jackson, MS
  • NPI 1932892601

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Connie Marie Brunson, PA

  • Medical Physician Assistant
  • Baton Rouge, LA
  • NPI 1841381647
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305763200000",
    "number": "1972645216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 GOODWOOD BLVD",
            "address_2": "SUITE 105",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70806",
            "telephone_number": "225-413-4361",
            "fax_number": "225-765-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD",
            "address_2": "PLAZA 1 SUITE 406",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70810",
            "telephone_number": "225-765-3456",
            "fax_number": "225-765-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF THE LAKE REGIONAL MEDICA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2011-05-19",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS SERVICES",
        "authorized_official_telephone_number": "225-765-4251"
    },
    "taxonomies": [
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1445584",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Our Lady Of The Lake Hospital Inc Pediatric Pulmonary Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Our Lady of the Lake Physician Group LLC (Lake Physician Group Cardiology Ser)
• Our Lady of the Lake Physician Group LLC (Pediatric Emergency Services)
• Our Lady of the Lake Physician Group, LLC
• Our Lady of the Lake Physician Group, LLC
• Our Lady of the Lake Plastic Clinic (Our Lady of the Lake Regional Medical Center)
• Our Lady of the Lake Regional Medical Center (Our Lady of the Lake Hospital Inc Pediatric Pulmonary Clinic Sleep Lab)
• Our Lake of the Lake Head and Neck Ce
• Our Lake of the Lake Hospital Inc (OLOL Professional Services)
• David Michael Ourso, FNP-C
• Jena Leigh Ourso, LCSW

• Pediatric Pulmonology Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Pediatric Pulmonology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.