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MMG NELSON RD LLC
NPI 1295103844
General Practice in Lake Charles, LA

Active since September 11, 2015CLIA 19D2153570 · Waiver
4345 NELSON RD STE 102, LAKE CHARLES, LA 70605(337) 480-7900(337) 602-6358 Get Directions Write a Review

NPPES record last updated: December 4, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 4, 2023, Jul 18, 2022, Aug 23, 2021 and 1 more (4 updates tracked since 2019).

About Mmg Nelson Rd Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MMG NELSON RD LLC (NPI 1295103844) is a healthcare organization registered as a general practice in Lake Charles, Louisiana and active in the NPI registry since September 2015. The organization holds a CLIA Waiver certificate valid through August 27, 2028 and lists Dawn Johnson-hatcher, Cfo, as its authorized official.

NPPES Registry Identity

NPI1295103844
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameMMG NELSON RD LLC
Location Address4345 NELSON RD STE 102Lake Charles, LA 70605-4183
Mailing AddressPo Box 123594 Dept 3594Dallas, TX 75312-3594 · (337) 494-2921 · Fax (337) 494-6523
Phone(337) 480-7900
Fax(337) 602-6358
Organization SubpartYesParent: Memorial Medical Group
Authorized OfficialDawn Johnson-hatcherCfo · (337) 494-2094
Enumeration DateSeptember 11, 2015
Last NPPES UpdateDecember 4, 20234 updates tracked since enumeration
NPPES CertifiedDecember 4, 2023
✔ NPI 1295103844 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedPsychiatry & Neurology · NeurologyTaxonomy 2084N0400X
4345 NELSON RD STE 102, Lake Charles, LA 70605
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mmg Nelson Rd Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Mmg Nelson Rd LLC, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 8 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Joshua Bacon, MD
Family Practice
NPI 1396274551
4345 NELSON RD STE 102
Lake Charles, LA 70605
(337) 480-7900
✔ PECOSSame address
Christian Leblanc, MD
Family Practice
NPI 1689115966
4345 NELSON RD STE 102
Lake Charles, LA 70605
(337) 480-7900
✔ PECOS✔ Accepts MedicareSame address
Kendra Meche, NP
Nurse Practitioner
NPI 1326295239
4345 NELSON RD STE 102
Lake Charles, LA 70605
(337) 480-7900
✔ PECOS✔ Accepts MedicareSame address
William Nabours, MD
Family Practice
NPI 1659371193
4345 NELSON RD STE 102
Lake Charles, LA 70605
(337) 480-7900
✔ PECOSSame address
Jennifer Trombatore, FNP
Nurse Practitioner
NPI 1346893732
4345 NELSON RD STE 102
Lake Charles, LA 70605
(337) 480-7999
✔ PECOS✔ Accepts MedicareSame address
Joshua Whatley, MD
Family Practice
NPI 1386961787
4345 NELSON RD STE 102
Lake Charles, LA 70605
(337) 480-7900
✔ PECOS✔ Accepts MedicareSame address
Logan Soileau, DO
Family Practice
NPI 1245811777
2750 ASTER ST
Lake Charles, LA 70601
(337) 480-8900
✔ PECOS✔ Accepts Medicare3.4 mi
Robert Vangossen, MD
Family Practice
NPI 1437546595
2750 ASTER ST
Lake Charles, LA 70601
(373) 480-8900
✔ PECOS✔ Accepts Medicare3.4 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D2153570

Mmg/Nelson Rd · Lake Charles, LA
Active · expires Aug 27, 2028
CLIA Number19D2153570
Laboratory TypePhysician Office
Certificate Effective DateAugust 28, 2026
Certificate Expiration DateAugust 27, 2028
Laboratory DirectorJohsh Whatley
Laboratory Phone(337) 480-7900
Laboratory LocationMmg/Nelson Rd4345 Nelson Road, Lake Charles, LA 70605
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mmg Nelson Rd LLC's NPI number?

The NPI number for Mmg Nelson Rd LLC is 1295103844. It was assigned to this organization in the NPPES registry on September 11, 2015.

Where is Mmg Nelson Rd LLC located?

Mmg Nelson Rd LLC is located at 4345 Nelson Rd Ste 102, Lake Charles, LA 70605. The listed phone number is (337) 480-7900.

What is Mmg Nelson Rd LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Mmg Nelson Rd LLC enrolled in Medicare?

Yes. Mmg Nelson Rd LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mmg Nelson Rd LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Mmg Nelson Rd LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Family Practice (6) and Nurse Practitioner (2). Of these, 6 practice at this address and 8 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mmg Nelson Rd LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D2153570) is associated with this NPI, valid through August 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mmg Nelson Rd LLC accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Blue Cross and Blue Shield of Louisiana and 1 other insurer list Mmg Nelson Rd LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mmg Nelson Rd LLC was last updated on December 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.