OUR LADY OF THE LAKE PHYSICIAN GROUP LLC (NPI# 1174662035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174662035 |
| Entity Type | Organization |
| Organization Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Practice Address |
230 Roberts Dr Suite H New Roads LA 70760-2661 |
| Mailing Address |
2051 Silverside Dr Suite 120 Baton Rouge LA 70808-9005 |
| Practice Telephone | 2256387033 |
| Practice Fax Number | 2256387034 |
| Mailing Telephone | 2257654226 |
| Mailing Fax Number | 2257659244 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2012-12-10 |
| Authorized Official Name | ELONA SHARBAUGH (VP PHYSICIAN PRACTICES) |
| Authorized Official Telephone | 2254908806 |
| Is Organization Subpart | Y |
| Parent Organization Name | OUR LADY OF THE LAKE HOSPITAL INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1447501 | 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 |
| 1033494943 | Our Lady of The Lake Physician Group LLC | Allergy & Immunology | 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 |
| 1184671455 | Our Lady of The Lake Physician Group LLC | Surgery | 4950 Essen Ln, Baton Rouge, LA 70809-3738 | 2006-05-30 |
| Street Address |
230 ROBERTS DR SUITE H |
| City | NEW ROADS |
| State | LA |
| Zip Code | 70760-2661 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992700256 | Joe M. Gannon | Ophthalmology | 230 Roberts Dr, Ste J, New Roads, LA 70760-2661 | 2005-06-14 |
| 1629343959 | Ashley Doucet Bordelon | Internal Medicine | 230 Roberts Dr, Suite I, New Roads, LA 70760-2661 | 2012-03-20 |
| 1316225568 | Coastal Foot Clinic, A P.C. | Podiatrist | 230 Roberts Dr, Suite G, New Roads, LA 70760-2661 | 2011-07-21 |
| 1487829842 | Coastal Foot Clinic Inc | Podiatrist | 230 Roberts Dr, Suite G, New Roads, LA 70760-2661 | 2008-04-28 |
| 1356480214 | Our Lady of The Lake Physician Group LLC | Physician Assistant | 230 Roberts Dr, Suite B, New Roads, LA 70760-2661 | 2007-02-06 |
| 1639268196 | Richard Gerard Palecki | Podiatrist | 230 Roberts Dr, Suite G, New Roads, LA 70760-2661 | 2006-10-12 |
| 1306945977 | Donald W Doucet Md and Associates LLC | Internal Medicine | 230 Roberts Dr, Suite I, New Roads, LA 70760-2661 | 2006-09-21 |
| 1194732057 | Jason Joseph Picard | Internal Medicine | 230 Roberts Dr, Suite I, New Roads, LA 70760-2661 | 2006-08-02 |
| 1477560761 | Donald William Doucet | Internal Medicine | 230 Roberts Dr, Suite I, New Roads, LA 70760-2661 | 2006-08-01 |
| 1124001755 | Joe M. Gannon, M.d. A Professional Medical Corp | Ophthalmology | 230 Roberts Dr, Suite J, New Roads, LA 70760-2661 | 2005-11-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417417932 | Talana Butler | Counselor | 8637 Pecan Drive East, New Roads, LA 70760 | 2019-03-21 |
| 1689138018 | Innis Community Health Center, Inc | Clinic/Center | 8434 Pointe Coupee Road, New Roads, LA 70760 | 2019-01-30 |
| 1790156073 | Erica Noel Kimble | Case Manager/Care Coordinator | 1919 Hospital Rd., New Roads, LA 70760 | 2015-10-13 |
| 1497125462 | Deanderia D Gremillion | Counselor | 1919 A Hospital Rd, New Roads, LA 70760 | 2015-10-02 |
| 1720458961 | Lacie Ourso Kemp | Case Manager/Care Coordinator | 1919 Hospital Road, Ste A, New Roads, LA 70760 | 2015-09-30 |
| 1093184467 | Pointe Coupee Council On Aging | Non-emergency Medical Transport (VAN) | 2112 False River Drive, New Roads, LA 70760 | 2015-09-16 |
| 1417154766 | Robin Diane Moeller | Counselor | 112 W. Main Street, New Roads, LA 70760 | 2007-06-29 |
| 1851503890 | Toni Guerin | Speech-Language Pathologist | 142 New Roads St., New Roads, LA 70760 | 2007-05-03 |
| 1295955458 | Pointe Coupee Parish Schools | Clinic/Center | 1662 La Hwy. 1, New Roads, LA 70760 | 2007-04-27 |
| 1861617664 | Kevin D Flint | Dentist | 282 Hospital Road, New Roads, LA 70760 | 2007-04-16 |
| Find all providers in zip 70760 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376870584 | Cecil James Bergeron | Family Medicine | 9207 False River Rd, New Roads, LA 70760-4101 | 2009-11-09 |
| 1073513941 | Carl Eugene Mclemore Jr. | Family Medicine | 310 Durel Dr, New Roads, LA 70760-2973 | 2005-07-21 |
| 1710372974 | Andrew Michael Parks | Family Medicine | 310 Durel Dr, New Roads, LA 70760 | 2015-04-03 |
| 1124281753 | Harry John Kellerman | Family Medicine | 2202 False River Dr, New Roads, LA 70760 | 2008-07-03 |
| 1396729513 | Carol S Swift | Family Medicine | 310 Durel Dr, New Roads, LA 70760-2973 | 2005-12-01 |
| 1811997141 | Paul Bradley Rachal | Family Medicine | 310 Durel Dr, New Roads, LA 70760-2973 | 2005-07-28 |
| 1255331039 | Louis Victor Montelaro | Family Medicine | 310 Durel Dr, New Roads, LA 70760-2973 | 2005-07-22 |
| 1609876473 | Brian Joseph Leblanc | Family Medicine | 310 Durel Dr, New Roads, LA 70760-2973 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568060135 | Audubon Family Medicine LLC | Family Medicine | 2301 Moss St, Lafayette, LA 70501-2125 | 2020-10-15 |
| 1588270581 | Wk Palmetto Family Practice | Family Medicine | 4200 Palmetto Rd, Benton, LA 71006-9420 | 2020-09-16 |
| 1255941498 | Concierge Medical Services | Family Medicine | 4108 Vendome Pl, New Orleans, LA 70125-2739 | 2020-08-03 |
| 1922621390 | Partners In Primary Care La PC | Family Medicine | 7551 Youree Dr Ste 11, Shreveport, LA 71105-5533 | 2020-05-20 |
| 1760005136 | Partners In Primary Care La PC | Family Medicine | 2900 E Texas St Ste 100, Bossier City, LA 71111-3275 | 2020-05-20 |
| 1871116244 | Partners In Primary Care La PC | Family Medicine | 537 Bertrand Dr Ste F0a, Lafayette, LA 70506-5556 | 2020-05-20 |
| 1578185781 | Prestige Medical Staffing and Marketing | Family Medicine | 4108 Vendome Place, New Orleans, LA 70125 | 2020-05-11 |
| 1487275939 | La Health Solutions-laplace LLC | Family Medicine | 1524 W Airline Hwy, La Place, LA 70068-3725 | 2020-05-06 |
| 1316575434 | Southern Healthcare of Louisiana | Family Medicine | 1340 Gause Blvd W, Slidell, LA 70460 | 2020-04-01 |
| 1780219907 | Shirley Ann Burns | Family Medicine | 1201 South St, Vinton, LA 70668-4509 | 2020-03-09 |
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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.