Walter Gipson (NPI# 1023121555, PAC ID# 0244212454) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1023121555 |
| PAC ID by PECOS | 0244212454 |
| Professional Enrollment ID | I20040602000877 |
| Full Name | Walter Gipson |
| Organization Legal Name | OUR LADY OF THE LAKE PHYSICIAN GROUP LLC |
| Address |
1702 Hwy 11 N Our Lady of The Lake Physician Group Picayune Picayune MS 39466-2016 |
| Phone Number | 6017993130 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE |
| Graduation Year | 1993 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 4587849781 |
| Number of Group Practice Members | 474 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 190270 | SOUTHERN SURGICAL HOSPITAL |
| 250117 | HIGHLAND COMMUNITY HOSPITAL |
| 190040 | SLIDELL MEMORIAL HOSPITAL |
| 190204 | OCHSNER MEDICAL CENTER - NORTHSHORE, L L C |
| Address | Phone | Organization |
|---|---|---|
| 1702 Hwy 11 N, Our Lady of The Lake Physician Group Picayune, Picayune, MS 39466-2016 | 6017993130 | 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 |
| Shantan Ravula | Family Medicine | Our Lady of The Lake Physician Group LLC | 14225 Hwy 73, Prairieville, LA 70769-3616 |
| 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 |
| Street Address |
1702 HWY 11 N OUR LADY OF THE LAKE PHYSICIAN GROUP PICAYUNE |
| City | PICAYUNE |
| State | MS |
| Zip | 39466-2016 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Adam Louis Robin | Physical Therapy | Southern Physical Therapy Clinic Inc | 1620 Hwy 11 N, Suite E, Picayune, MS 39466-2070 |
| John W Houston Jr. | Physical Therapy | Southern Physical Therapy Clinic Inc | 1620 Hwy 11 N, Suite E, Picayune, MS 39466-2070 |
| Allen R Calabresi | Hematology/oncology | Slidell Memorial Hospital | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Brittany Shaw | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Ronald Dale Leblanc | Hematology/oncology | Slidell Memorial Hospital | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Mary Catherine Hess | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Grace P Ford | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Cyril Vk Bethala | Cardiovascular Disease (cardiology) | Cardiology Institute, Inc | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Judith Baker | Nurse Practitioner | Pelican Urgent Care, Ms, LLC | 1839 Cooper Rd, Suite 100, Picayune, MS 39466-2835 |
| Jason T Lane | Certified Registered Nurse Anesthetist (crna) | Deep South Anesthesia, Inc | 801 Goodyear Blvd, Picayune, MS 39466-3221 |
| Find all physicians in zip 39466 | |||
| City | PICAYUNE |
| Zip Code | 39466 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | PICAYUNE + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Walter Gipson.
| 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.