Dimitri Nicholas Pagoulato, PAC - Medicare Physician Assistant in Baker, LA

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Dimitri Nicholas Pagoulato, PAC is a medicare enrolled "Physician Assistant" in Baker, Louisiana. He graduated from nursing school in 2008 and has 18 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Our Lady Of The Lake Physician Group Llc and his current practice location is 6516 E Myrtle Ave, Baker, Louisiana. You can reach out to his office (for appointments etc.) via phone at (225) 774-7320.

Dimitri Nicholas Pagoulato is licensed to practice in Louisiana (license number 200193) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1194988915.

Contact Information

Dimitri Nicholas Pagoulato, PAC
6516 E Myrtle Ave,
Baker, LA 70714-4348
(225) 774-7320
(225) 774-5432

Map and Direction




Provider's Profile

Full NameDimitri Nicholas Pagoulato
GenderMale
SpecialityPhysician Assistant
Experience18 Years
Location6516 E Myrtle Ave, Baker, Louisiana
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Dimitri Nicholas Pagoulato graduated from nursing school in 2008
  NPI Data:
  • NPI Number: 1194988915
  • Provider Enumeration Date: 07/02/2008
  • Last Update Date: 03/14/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 9335215243
  • Enrollment ID: I20081105000004

Medical Identifiers

Medical identifiers for Dimitri Nicholas Pagoulato such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1194988915NPI-NPPES
1189871MedicaidLA

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant 200193 (Louisiana)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Lane Regional Medical CenterZachary, LAHospital
Fmol Health | Our Lady Of The LakeBaton rouge, LAHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Our Lady Of The Lake Physician Group Llc4587849781637

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dimitri Nicholas Pagoulato allows following entities to bill medicare on his behalf.
Entity NameConvenient Care LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1164422630
PECOS PAC ID: 1153306816
Enrollment ID: O20040618000886
Entity NameOur Lady of the Lake Physician Group LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1033494943
PECOS PAC ID: 4587849781
Enrollment ID: O20120529000377
Entity NameLake Urgent Care Ascension LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1912243122
PECOS PAC ID: 0244479095
Enrollment ID: O20130627000023
Entity NameJuban Point Urgent Care LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1033589379
PECOS PAC ID: 3678871217
Enrollment ID: O20160414000463
Entity NameMayfair Emergency Group, LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1750870226
PECOS PAC ID: 3375808645
Enrollment ID: O20180607002576

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dimitri Nicholas Pagoulato is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dimitri Nicholas Pagoulato, PAC
5959 S Sherwood Forest Blvd,
Baton Rouge, LA 70816-6038

Ph: (225) 774-7320		Dimitri Nicholas Pagoulato, PAC
6516 E Myrtle Ave,
Baker, LA 70714-4348

Ph: (225) 774-7320

Reviews and Comments


Physician Assistant Nurses in Baker, LA

Alice Catherine Powell, P. A.
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 6516 E Myrtle Ave, Baker, LA 70714
Phone: 225-774-7320    Fax: 225-774-5432
Thikra Muhsin,
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 902 Main St, Baker, LA 70714
Phone: 225-500-2504    
Ballard Jackson Mann, P.A.
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 6516 E Myrtle Ave, Baker, LA 70714
Phone: 225-774-7320    Fax: 225-774-5432

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.