Shantan Ravula (NPI# 1245465541, PAC ID# 4587892740) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1245465541 |
| PAC ID by PECOS | 4587892740 |
| Professional Enrollment ID | I20140115000171 |
| Full Name | Shantan Ravula |
| Organization Legal Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Address |
14225 Hwy 73 Prairieville LA 70769-3616 |
| Phone Number | 2256478511 |
| Gender | M |
| Medical School | UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | FAMILY MEDICINE |
| Secondary Specialties | SLEEP MEDICINE |
| Group Practice PAC ID | 4587849781 |
| Number of Group Practice Members | 474 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 190064 | OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 14225 Hwy 73, Prairieville, LA 70769-3616 | 2256478511 | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Organization Legal Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Physicians | 443 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James Michael Robinson | Family Medicine | Our Lady of The Lake Physician Group LLC | 12525 Perkins Rd A, Baton Rouge, LA 70810-1907 |
| Kori Fogg Juban | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 34870 La Hwy 1019, Denham Springs, LA 70706-0659 |
| Michelle Duhe | Family Medicine | Our Lady of The Lake Physician Group LLC | 26739 La Hwy 1032, Denham Springs, LA 70726-4926 |
| Swapna G Kallu | Internal Medicine | Our Lady of The Lake Physician Group LLC | 214 Clinic Dr, Donaldsonville, LA 70346-4309 |
| Montrell Martin-duhe | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 4463 La Hwy 1 S A, Port Allen, LA 70767-5990 |
| Joshua R Clark | Family Medicine | Our Lady of The Lake Physician Group LLC | 59315 River W Dr, Suite C, Plaquemine, LA 70764-6553 |
| Hollie B Ortis | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 13489 Hwy 431, Suite A, Saint Amant, LA 70774-3213 |
| Daniel Kevin Lavie | Hematology/oncology | Our Lady of The Lake Physician Group LLC | 4950 Essen Ln, Suite 400, Baton Rouge, LA 70809-3738 |
| Sheri A Ammons | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 5428 Odonovan Dr B, Baton Rouge, LA 70808-4374 |
| Sharon Jackson | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 5247 Didesse Dr, Baton Rouge, LA 70808-9153 |
| Street Address |
14225 HWY 73 |
| City | PRAIRIEVILLE |
| State | LA |
| Zip | 70769-3616 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michelle Duplantis | Nurse Practitioner | Our Lady of The Lake Physician Group LLC | 14225 Hwy 73, Prairieville, LA 70769-3616 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Victor A Mccoy | Diagnostic Radiology | Radiology Specialists LLC | 36464 Plantation Blvd, Prairieville, LA 70769-3224 |
| Jessica B Lee | Chiropractic | 37283 Swamp Rd, Suite 1001, Prairieville, LA 70769-3298 | |
| Bradley T Chapman | Physical Therapy | Advantage Therapy Services, L.L.C. | 17094 Airline Hwy, Prairieville, LA 70769-3400 |
| Brittany Werling | Physical Therapy | Advantage Therapy Services, L.L.C. | 17094 Airline Hwy, Prairieville, LA 70769-3400 |
| Albert J Pickett | Physical Therapy | Advantage Therapy Services, L.L.C. | 17094 Airline Hwy, Prairieville, LA 70769-3400 |
| Jennifer S Nickens | Nurse Practitioner | Minuteclinic Diagnostic of Louisiana, L.L.C. | 17122 Airline Hwy, Prairieville, LA 70769-3402 |
| Glenn A Mason | Diagnostic Radiology | Red River Consultants Inc | 18141 Pinehurst Dr, Prairieville, LA 70769-3454 |
| John K Lindsay | Cardiovascular Disease (cardiology) | Cardiovascular Institute of The South, Apmc | 37292 Market Place Dr, Suite A, Prairieville, LA 70769-3487 |
| Bonnie L Gaudin | Physician Assistant | Lake Urgent Care Ascension LLC | 14350 Hwy 73, Prairieville, LA 70769-3617 |
| Britni N Mcconnell | Nurse Practitioner | Lake Urgent Care Ascension LLC | 14350 Hwy 73, Prairieville, LA 70769-3617 |
| Find all physicians in zip 70769 | |||
| City | PRAIRIEVILLE |
| Zip Code | 70769 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | PRAIRIEVILLE + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Shantan Ravula.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.