Michael Ray Melancon, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD015178 Issued in LA

Practice address

4650 Ambassador Caffery Pkwy
Suite 105
Lafayette, LA 70508-6926

Phone

(337) 989-8080

Fax

(337) 981-0913

NPI assigned

Jul 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Louisiana State University School of Medicine in New Orleans, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

La Imaging Clinic, LLCGroup PAC ID 9234290925, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• La Imaging Clinic, LLC

  • Speech-Language Pathologist
  • Alexandria, LA
  • NPI 1568628972
  Medicare reassignment Care Compare group NPD
• Moss Street Kid Med LLC

  • Clinic/Center
  • Lafayette, LA
  • NPI 1336268184
  Medicare reassignment NPD
• Michael R Melancon, MD

  • Pediatrics Physician
  • Lafayette, LA
  • NPI 1750640058
  NPD (past) Authorized official
• Sola Pediatrics

  • Pediatrics Physician
  • Lafayette, LA
  • NPI 1124565296
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992737621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 AMBASSADOR CAFFERY PKWY",
            "address_2": "SUITE 105",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086926",
            "telephone_number": "337-989-8080",
            "fax_number": "337-981-0913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 AMBASSADOR CAFFERY PKWY",
            "address_2": "SUITE 105",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086926",
            "telephone_number": "337-989-8080",
            "fax_number": "337-981-0913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELANCON",
        "first_name": "MICHAEL",
        "middle_name": "RAY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD015178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA STATE LICENSE",
            "identifier": "015178",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "721165262",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1324833",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth M. Melancon, M.D.
• Jennifer Melancon, PT,DPT,CKTP
• Jill Melancon, CSFA
• Kay Christine Melancon, AGACNP
• Mark Francis Melancon, PLPC
• Sarah Estelle Melancon, LPC, ATR
• Melanie Mier MD a Professional Medical Corporation
• Asmamaw Melese
• Leah Menard-Neumann, FNP
• Amadia Menard

• Pediatrics Physician in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.