OUR LADY OF THE LAKE PHYSICIAN GROUP LLC (NPI# 1033494943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033494943 |
| Entity Type | Organization |
| Organization Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Practice Address |
7777 Hennessy Blvd Ste 6002 Baton Rouge LA 70808-4300 |
| Mailing Address |
2051 Silverside Dr Ste 260 Baton Rouge LA 70808-9005 |
| Practice Telephone | 2257657727 |
| Practice Fax Number | 2257665645 |
| Mailing Telephone | 2254906301 |
| Mailing Fax Number | 2257659539 |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2015-10-08 |
| Authorized Official Name | JEFFREY LIMBOCKER (CFO) |
| Authorized Official Telephone | 2257657727 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians | ||
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
Allopathic & Osteopathic Physicians | ||
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208C00000X | Colon & Rectal Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208M00000X | Hospitalist | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 2305042 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518006568 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 160 Hospital Rd, New Roads, LA 70760-2617 | 2007-02-06 |
| 1912282831 | Our Lady of The Lake Physician Group LLC | Pediatrics | 7777 Hennessy Blvd, Ste 6002, Baton Rouge, LA 70808-4300 | 2011-10-12 |
| 1356643399 | Our Lady of The Lake Physician Group LLC | Internal Medicine | 8415 Goodwood Blvd, Ste 105, Baton Rouge, LA 70806-7851 | 2010-11-24 |
| 1447399308 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 310 Durel Dr, New Roads, LA 70760-2973 | 2007-02-06 |
| 1356480214 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 230 Roberts Dr, Suite B, New Roads, LA 70760-2661 | 2007-02-06 |
| 1174662035 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 230 Roberts Dr, Suite H, New Roads, LA 70760-2661 | 2007-02-06 |
| 1184671455 | Our Lady of The Lake Physician Group LLC | Surgery | 4950 Essen Ln, Baton Rouge, LA 70809-3738 | 2006-05-30 |
| Street Address |
7777 HENNESSY BLVD STE 6002 |
| City | BATON ROUGE |
| State | LA |
| Zip Code | 70808-4300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336143841 | Jeffrey Dean Hyde | Internal Medicine | 7777 Hennessy Blvd, Suite 1000, Baton Rouge, LA 70808-4300 | 2005-06-13 |
| 1487211397 | Karrie G Mccoy | Nurse Practitioner | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2019-05-27 |
| 1912466160 | Paige Cantrell Guillory | Student in an Organized Health Care Education/Training Program | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2019-03-18 |
| 1699267666 | Osaretin Charles Aimuyo | Pediatrics | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2018-06-05 |
| 1962992883 | John Ghassan | Student in an Organized Health Care Education/Training Program | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2018-05-16 |
| 1003312414 | Jamie Nicole Scharfschwerdt | Student in an Organized Health Care Education/Training Program | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2018-04-04 |
| 1356859888 | Kristen Pilcher Boudreaux | Nurse Anesthetist, Certified Registered | 7777 Hennessy Blvd, Ste 301, Baton Rouge, LA 70808 | 2018-01-18 |
| 1548784192 | Erickia Lee Le Meunier | Nurse Practitioner | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2017-07-26 |
| 1215457023 | Amy Miller | Nurse Practitioner | 7777 Hennessy Blvd, Baton Rouge, LA 70808-4300 | 2017-06-22 |
| 1053852806 | Kathryn Tetreault | Nurse Anesthetist, Certified Registered | 7777 Hennessy Blvd, Suite 301, Baton Rouge, LA 70808-4300 | 2017-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790313161 | Leah Michelle Dlugolecki | Student in an Organized Health Care Education/Training Program | Lsu Psychiatry Residency Program, 5246 Brittany Drive, Baton Rouge, LA 70808 | 2020-03-31 |
| 1003376302 | Kristina Pham | Student in an Organized Health Care Education/Training Program | 5246 Brittany Drive, 3rd Floor, Baton Rouge, LA 70808 | 2019-03-22 |
| 1083174486 | John Jay Hogan | Student in an Organized Health Care Education/Training Program | Lsu Emergency Medicine Residency Program, 5246 Brittany Drive, Baton Rouge, LA 70808 | 2019-03-21 |
| 1033682075 | Joseph Bertell Davis Jr. | Case Manager/Care Coordinator | 2460 College Drive, Baton Rouge, LA 70808 | 2019-01-02 |
| 1508340886 | Jennifer Miatech | Student in an Organized Health Care Education/Training Program | 8585 Picardy Ave., Medical Tower 2, Baton Rouge, LA 70808 | 2018-09-21 |
| 1700389137 | Jenee Robins | Case Manager/Care Coordinator | 2100 College Dr Apt 159, Baton Rouge, LA 70808 | 2018-03-12 |
| 1952812893 | Da Vonna Dents | Behavioral Analyst | 418 Stoney Creek Ave, Baton Rouge, LA 70808 | 2017-10-18 |
| 1962925669 | Katharine Elizabeth Blum | Counselor | 7936 Wrenwood Blvd. Ste A, Baton Rouge, LA 70808 | 2017-07-25 |
| 1801316120 | Amie Jackson | Social Worker | 5420 Corporate Blvd. Ste 308, Baton Rouge, LA 70808 | 2017-06-27 |
| 1235660713 | Melissa A Eddy-shelby | Student in an Organized Health Care Education/Training Program | 5000 Hennessy Blvs, Suite 6004, Baton Rouge, LA 70808 | 2017-03-25 |
| Find all providers in zip 70808 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518581305 | Ochsner Clinic LLC | Internal Medicine | 10150 Bluebonnet Blvd, Baton Rouge, LA 70810-7131 | 2020-06-08 |
| 1417583428 | Garbutt Medical LLC | Internal Medicine | 9373 Barringer Foreman Rd Bldg 2, Baton Rouge, LA 70809-5716 | 2020-03-21 |
| 1437784907 | Affinity Health Group, LLC | Internal Medicine | 13348 Coursey Blvd, Baton Rouge, LA 70816-4970 | 2020-03-05 |
| 1881121770 | Manish Mishra | Internal Medicine | 4550 Government St, Baton Rouge, LA 70806-5817 | 2017-05-22 |
| 1750822540 | Live Oak Aesthetics and Wellness | Internal Medicine | 8225 Ymca Plaza Dr, Baton Rouge, LA 70810-0922 | 2017-03-14 |
| 1467814004 | Rajendra Boyilla | Internal Medicine | 7807 N Jefferson Place Cir, Baton Rouge, LA 70809-8632 | 2016-03-23 |
| 1063884047 | Lourdes Rodriguez | Internal Medicine | 5428 O’ Donovan Dr, Ste C, Baton Rouge, LA 70808 | 2015-10-29 |
| 1467846428 | Mary Catherine Gaston | Internal Medicine | 755 Highland Park Dr, Baton Rouge, LA 70808-5644 | 2015-03-26 |
| 1174917652 | Eric Frusha | Internal Medicine | 8585 Picardy Ave Ste 410, Baton Rouge, LA 70809-3749 | 2015-03-24 |
| 1114356979 | Baton Rouge General Primary Care, LLC | Internal Medicine | 5353 Florida Blvd, Baton Rouge, LA 70806-4130 | 2013-11-02 |
| Find all providers in BATON ROUGE | ||||
| City | BATON ROUGE |
| Zip Code | 70808 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.