PONTCHARTRAIN MEDICAL GROUP, A PROFESSIONAL CORPORATION (NPI# 1356704357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356704357 |
| Entity Type | Organization |
| Organization Name | PONTCHARTRAIN MEDICAL GROUP, A PROFESSIONAL CORPORATION |
| Practice Address |
2014 W Pinhook Rd Suite 301 Lafayette LA 70508-8504 |
| Mailing Address |
200 Powell Pl Brentwood TN 37027-7514 |
| Practice Telephone | 6157278392 |
| Practice Fax Number | 6154578094 |
| Mailing Telephone | 6157278392 |
| Mailing Fax Number | 6154578094 |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2017-12-27 |
| Authorized Official Name | MICHAEL CARTWRIGHT (CHAIRMAN) |
| Authorized Official Telephone | 6157279382 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
2014 W PINHOOK RD SUITE 301 |
| City | LAFAYETTE |
| State | LA |
| Zip Code | 70508-8504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225413354 | A First Name Basis Home Care | In Home Supportive Care | 2014 W Pinhook Rd, Suite 110, Lafayette, LA 70508-8504 | 2015-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868676 | Cypress Bend Oral & Maxillofacial Surgery | Dentist | 106 Rue Bastille, Lafayette, LA 70508 | 2020-07-13 |
| 1184250607 | Learning Grove Therapy LLC | Clinic/Center | 105 Anaheim Lane, Lafayette, LA 70508 | 2020-03-16 |
| 1780218727 | Jennifer Trumps | Case Manager/Care Coordinator | 200 Entergy Parkway, Lafayette, LA 70508 | 2020-02-28 |
| 1740749605 | Hunter Sy Arceneaux | Physical Therapist | 1700 Kaliste Saloom Road, Building 3, Suite 300, Lafayette, LA 70508 | 2019-03-19 |
| 1295292787 | Brad Michael Gros | Counselor | 160 South Beadle Road, Lafayette, LA 70508 | 2019-02-21 |
| 1205337581 | Alternative Perspectives, LLC | Clinic/Center | 2807 Kaliste Saloom Rd Ste B, Lafayette, LA 70508 | 2018-02-22 |
| 1124528807 | Zachariah James Hebert | Counselor | 1602 W Pinhook Rd Suite 100a, The Family Tree, Lafayette, LA 70508 | 2018-02-19 |
| 1164934477 | Ilyas Munshi, Md Apmc | Non-Pharmacy Dispensing Site | 99 W. Martial Ave, Lafayette, LA 70508 | 2017-10-26 |
| 1447761226 | Louisiana Orthopaedic Specialists, LLC | Durable Medical Equipment & Medical Supplies | 4231 Ambassador Caffery Pkwy, Suite 102, Lafayette, LA 70508 | 2017-10-19 |
| 1306365457 | Mk Dixon Counseling and Consulting | Counselor | 105 Industrial Parkway, Lafayette, LA 70508 | 2017-09-10 |
| Find all providers in zip 70508 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639103567 | David J Rees | Psychiatry & Neurology | 302 Dulles Dr, Suite 1, Lafayette, LA 70506-3008 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225477235 | Angela K. Jubert | Psychiatry & Neurology | 5620 Read Blvd Fl 5, New Orleans, LA 70127-3106 | 2013-06-24 |
| 1619119567 | Nicholas Fluitt | Psychiatry & Neurology | 111 N Causeway Blvd Ste 222, Mandeville, LA 70448 | 2009-03-24 |
| 1699781591 | Brian D Monette | Psychiatry & Neurology | 1112 E Ascension Complex Ave., Gonzales, LA 70737 | 2006-07-31 |
| 1679501712 | Anwar Ismail | Psychiatry & Neurology | 4113 Williams Blvd., Kenner, LA 70065 | 2006-06-29 |
| 1730186750 | Alphonse Kenison Roy IIi | Psychiatry & Neurology | 4933 Wabash St, Metairie, LA 70001-1031 | 2005-07-05 |
| 1477103240 | Anthony Micheal Peperone | Psychiatry & Neurology | 4430 Highway 22 Ste B, Mandeville, LA 70471-3310 | 2019-09-13 |
| 1730660176 | Epiphany Healthcare System, Inc | Psychiatry & Neurology | 906 C M Fagan Dr Bldg A, Suite 6a, Hammond, LA 70403 | 2018-08-23 |
| 1104280825 | Jerrell Mitchell | Psychiatry & Neurology | 1542 Tulane Ave, New Orleans, LA 70112-2865 | 2016-04-08 |
| 1790129617 | Narissa Etwaroo | Psychiatry & Neurology | 1501 Kings Hwy, Psychiatry, Shreveport, LA 71103 | 2013-04-22 |
| 1306020698 | Biobehavioral Medicine Company, LLC | Psychiatry & Neurology | 4933 Wabash St, Metairie, LA 70001-1031 | 2007-12-21 |
| Find all providers with the same taxonomy | ||||
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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.