| Mmg/moss Campus | |
|
1000 Walters St Lake Charles LA 70607-4647 | |
| (337) 480-8066 | |
| (337) 480-8109 |
| Full Name | Mmg/moss Campus |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 1000 Walters St, Lake Charles, Louisiana |
| Authorized Official Name and Position | Dawn Johnson-hatcher (CFO) |
| Authorized Official Contact | 3374942094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mmg/moss Campus Po Box 122108 Dept 2108 Dallas TX 75312-2108 Ph: (337) 494-2921 | Mmg/moss Campus 1000 Walters St Lake Charles LA 70607-4647 Ph: (337) 480-8066 |
| NPI Number | 1215161922 |
|---|---|
| Provider Enumeration Date | 05/08/2009 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 7012061930 |
|---|---|
| Medicare Enrollment ID | O20090812000167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215161922 | NPI | - | NPPES |
| 09-00013263 | Other | LA | OCCUPATIONAL LICENSE |
| 2353993 | Medicaid | LA |
| Provider Name | Mohammad S Sarwar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407823644 PECOS PAC ID: 1557311768 Enrollment ID: I20050126000136 |
| Provider Name | Gerard J Guidry |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1235198599 PECOS PAC ID: 0941254544 Enrollment ID: I20050308000005 |
| Provider Name | Therese a Novak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699803361 PECOS PAC ID: 0547366494 Enrollment ID: I20070509000458 |
| Provider Name | Carlos M Choucino |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1386604338 PECOS PAC ID: 7810095676 Enrollment ID: I20070604000078 |
| Provider Name | Mary Hollingsworth Sherk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326014739 PECOS PAC ID: 0840388591 Enrollment ID: I20100308000477 |
| Provider Name | Ping Kok Lie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447210406 PECOS PAC ID: 5890974885 Enrollment ID: I20110124000172 |
| Provider Name | Muhammad Shaikh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396705752 PECOS PAC ID: 0547267510 Enrollment ID: I20110124001158 |
| Provider Name | Brenda F Daigle-murry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497067177 PECOS PAC ID: 5890958524 Enrollment ID: I20120516000680 |
| Provider Name | Jodie R Gwin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1760625230 PECOS PAC ID: 3577704105 Enrollment ID: I20130724000817 |
| Provider Name | Clayton M Maraist |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1780976266 PECOS PAC ID: 2365756632 Enrollment ID: I20150730011607 |
| Provider Name | Randalla Taren Reynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730516162 PECOS PAC ID: 5799087292 Enrollment ID: I20151230000049 |
| Provider Name | Collin S Bowe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760896625 PECOS PAC ID: 4183997620 Enrollment ID: I20170906001345 |
| Provider Name | Benjamin Martin Azevedo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821434432 PECOS PAC ID: 4284942012 Enrollment ID: I20170915001199 |
| Provider Name | Ashley M Mossbarger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114421112 PECOS PAC ID: 0446514483 Enrollment ID: I20180430000034 |
| Provider Name | Manicia S Liddell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568963866 PECOS PAC ID: 3779829908 Enrollment ID: I20190109001905 |
| Provider Name | Traci L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548734270 PECOS PAC ID: 8325380181 Enrollment ID: I20190425002573 |
| Provider Name | Ahmed R Abdelkarim |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1215171103 PECOS PAC ID: 8729217666 Enrollment ID: I20191209001464 |
| Provider Name | Joseph Dressler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245768472 PECOS PAC ID: 3274803028 Enrollment ID: I20200609002013 |
| Provider Name | Ashton a Adekanmbi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548791940 PECOS PAC ID: 3173896081 Enrollment ID: I20200713001739 |
| Provider Name | Jasmin M Demerson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396276713 PECOS PAC ID: 7113290651 Enrollment ID: I20200713001884 |
| Provider Name | Ajaypal Singh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235586249 PECOS PAC ID: 9436442530 Enrollment ID: I20200714002238 |
| Provider Name | Daniel Louis Verret |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891361259 PECOS PAC ID: 8022414333 Enrollment ID: I20210913002037 |
| Provider Name | Jamie Duncan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386862282 PECOS PAC ID: 0042371908 Enrollment ID: I20230707003249 |
| Provider Name | Eric W Linville |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1023514569 PECOS PAC ID: 8628431699 Enrollment ID: I20230824002120 |
| Provider Name | Brandi Lejeune |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083495006 PECOS PAC ID: 2264875558 Enrollment ID: I20240202002360 |
| Provider Name | Kamran Shafi Mohammad |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1770088106 PECOS PAC ID: 5991057861 Enrollment ID: I20240411003028 |
| Provider Name | Rilee Breann Como |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619730207 PECOS PAC ID: 4587003264 Enrollment ID: I20240415000509 |
| Provider Name | Andrew Aaron Paulk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487116778 PECOS PAC ID: 0446799035 Enrollment ID: I20240827003298 |
| Provider Name | Lakshmi Tatineni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417536293 PECOS PAC ID: 6709288863 Enrollment ID: I20240928000454 |
| Provider Name | Aimel Azizi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1144480997 PECOS PAC ID: 0345423158 Enrollment ID: I20241125000087 |
| Provider Name | Adaobi Umeaku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982280640 PECOS PAC ID: 5193253623 Enrollment ID: I20250113001132 |
| Provider Name | Brittnee Lett |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992321210 PECOS PAC ID: 5890117568 Enrollment ID: I20250304000798 |
| Provider Name | Ashhad Siddiqui |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992369730 PECOS PAC ID: 9436563350 Enrollment ID: I20250722003534 |
| Provider Name | Alia J Werblin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821583956 PECOS PAC ID: 2163828930 Enrollment ID: I20250722003611 |
| Provider Name | Jhonstanley D Searcy Schnaeidr |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104160357 PECOS PAC ID: 0941426993 Enrollment ID: I20250722003650 |
| Provider Name | Irina Hillman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114422375 PECOS PAC ID: 6608126529 Enrollment ID: I20250722003907 |
| Provider Name | Will Chapple |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386027472 PECOS PAC ID: 0547523052 Enrollment ID: I20250722004411 |
| Provider Name | Svitlana Shapovalova |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255829321 PECOS PAC ID: 3971909417 Enrollment ID: I20250722004435 |
| Provider Name | Yohannes Tilahun Mengistu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912292525 PECOS PAC ID: 0941522718 Enrollment ID: I20250723001806 |
| Provider Name | Brian Secrest |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396494472 PECOS PAC ID: 8224424437 Enrollment ID: I20250930003421 |
| Provider Name | Sara Dunham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477113892 PECOS PAC ID: 0941531172 Enrollment ID: I20251001001407 |
| Provider Name | Carlo Emilcar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417604448 PECOS PAC ID: 4284122961 Enrollment ID: I20251023003869 |
| Provider Name | Christopher Julien |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881293769 PECOS PAC ID: 4183112899 Enrollment ID: I20251023004588 |
| Provider Name | Hannah Pennick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346032992 PECOS PAC ID: 5890283386 Enrollment ID: I20251024004256 |
| Provider Name | Zafar Jadwet |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104408343 PECOS PAC ID: 6204325707 Enrollment ID: I20251026000418 |
| Provider Name | Haley E Knight |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396486676 PECOS PAC ID: 4284015421 Enrollment ID: I20251026000436 |
| Provider Name | Brandi Shanelle Buxton-cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518714757 PECOS PAC ID: 3971092016 Enrollment ID: I20251029003288 |
| Provider Name | Fabian Latorre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265782601 PECOS PAC ID: 9436539889 Enrollment ID: I20251122000382 |
| Provider Name | Momin Islam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528695665 PECOS PAC ID: 7315489051 Enrollment ID: I20260213004066 |
Iowa Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1717 Oak Park Blvd, Lake Charles, LA 70601 Phone: 337-582-7632 Fax: 337-582-7656 |
Family Medical Center. Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2750 Aster St, Lake Charles, LA 70601 Phone: 337-478-2650 Fax: 337-478-8183 |
Washington-marion Sbhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2802 Pineview St, Lake Charles, LA 70615 Phone: 337-217-4540 Fax: 337-439-5029 |
Headache and Wellness Center of Southwest Louisiana, LLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 803 W Bayou Pines Dr Ste B, Lake Charles, LA 70601 Phone: 337-508-2333 |
Imperial Health, LLP Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 501 Dr Michael Debakey Dr, Lake Charles, LA 70601 Phone: 337-433-8400 Fax: 337-312-6708 |
Kndl Partners Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4200 Nelson Rd, Lake Charles, LA 70605 Phone: 337-475-4748 Fax: 337-944-4421 |