CROSS LAKE EMERGENCY GROUP, LLC (NPI# 1013497114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013497114 |
| Entity Type | Organization |
| Organization Name | CROSS LAKE EMERGENCY GROUP, LLC |
| Practice Address |
2600 Greenwood Rd Shreveport LA 71103-3908 |
| Mailing Address |
200 Corporate Blvd Lafayette LA 70508-3870 |
| Practice Telephone | 3182124000 |
| Mailing Telephone | 8008939698 |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |
| Authorized Official Name | LISHA C FALK (VP OF CONTRACTING) |
| Authorized Official Telephone | 8008939698 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2400 Hospital Dr, Bossier City, LA 711112385 | 3182127000 | |
| 2510 Bert Kouns Industrial Loop, Shreveport, LA 711183119 | 3182125000 | |
| 8001 Youree Dr, Shreveport, LA 711152302 | 3182123000 |
| Street Address |
2600 GREENWOOD RD |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-3908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972508307 | Mary Cecola | Nurse Anesthetist, Certified Registered | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2005-06-13 |
| 1427675701 | Lakyn Paige Smith | Nurse Practitioner | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2020-07-02 |
| 1730645201 | Willis Knighton Medical Center, Inc. | Clinic/Center | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2019-02-20 |
| 1417479262 | Kristen Mccoy Keener | Nurse Practitioner | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2017-07-13 |
| 1689110538 | Penny Lynn Ford | Nurse Anesthetist, Certified Registered | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2017-01-17 |
| 1427508456 | Edward Glenn Bernatowicz | Pharmacist | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2016-10-13 |
| 1306237391 | Christina Maxwell | Nurse Anesthetist, Certified Registered | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2015-02-11 |
| 1467841270 | Houston Lacobee | Nurse Anesthetist, Certified Registered | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2015-01-16 |
| 1740688415 | Ana Costea | Emergency Medicine | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2014-12-12 |
| 1801205802 | Wkmc Cardiovascular Consultants | Internal Medicine | 2600 Greenwood Rd, Shreveport, LA 71103-3908 | 2014-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982871182 | Edward Locascio | Emergency Medicine | 1512 W Kirby Place, Department of Emergency Medicine, Shreveport, LA 71103-3822 | 2008-05-15 |
| 1780722686 | Joseph Salvador Bianca | Emergency Medicine | 715 Chinquapin Dr, Shreveport, LA 71106-7200 | 2007-02-02 |
| 1902950363 | Richard A Aycock II | Emergency Medicine | 2510 Bert Kouns Indistrial Loop, Shreveport, LA 71118 | 2007-01-23 |
| 1962555342 | Charles Leonard Black | Emergency Medicine | 7600 General Motors Blvd, Medical Department, Shreveport, LA 71129-9426 | 2007-01-19 |
| 1801820121 | Mary Ann Edens | Emergency Medicine | 1501 King's Highway, Shreveport, LA 71103 | 2006-07-10 |
| 1992738629 | Paul Bracey | Emergency Medicine | 6841 Fern Avenue, Suite 100, Shreveport, LA 71105 | 2006-07-08 |
| 1306875570 | Edward Ronald Samper | Emergency Medicine | 1666 E Bert Kouns Industrial Loop, Suite 105, Shreveport, LA 71105-5714 | 2006-07-01 |
| 1366482309 | Kenneth David Miller | Emergency Medicine | 11165 Heritage Oaks, Shreveport, LA 71106-8383 | 2006-06-07 |
| 1225084536 | John Kevin Netterville | Emergency Medicine | One St Mary Place, Shreveport, LA 71101 | 2006-05-26 |
| 1245206077 | Jerel L Raney | Emergency Medicine | 7045 Youree Dr, Shreveport, LA 71105-5108 | 2006-02-23 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
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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.