Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. RAPHAEL JOHN HIGGINBOTHAM M.D.
NPI 1477507531
Internal Medicine - Nephrology in Opelousas, LA

Q: What is Raphael Higginbotham's NPI number?

The NPI number for Raphael Higginbotham is 1477507531. It was assigned to this individual provider in the NPPES registry on May 20, 2006.

Q: What is Raphael Higginbotham's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Active since May 20, 2006PECOS EnrolledAccepts Medicare Assignment

60.64/100

CMS Quality Rating

927 E PRUDHOMME ST, OPELOUSAS, LA 70570(337) 594-8381 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. Raphael John Higginbotham M.d. NPPES

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

DR. RAPHAEL JOHN HIGGINBOTHAM M.D. (NPI 1477507531) is an individual nephrology provider in Opelousas, Louisiana, licensed in Louisiana (025644) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS, is affiliated with Ochsner Lafayette General Medical Center, and is a graduate of Louisiana State University School Of Medicine In New Orleans (2001).

NPPES Registry Identity

NPI1477507531

Entity TypeIndividualMale

Primary Taxonomy207RN0300X

Provider Legal NameDR. RAPHAEL JOHN HIGGINBOTHAMCredential: M.D.

Location Address927 E PRUDHOMME STOpelousas, LA 70570-8240

Mailing Address5018 Vidrine RdVille Platte, LA 70586-8707 · (504) 473-8079

Phone(337) 594-8381

Sole ProprietorNo

Medical School CMSLouisiana State University School Of Medicine In New OrleansGraduated 2001

Enumeration DateMay 20, 2006

Last NPPES UpdateJuly 13, 2026

✔ NPI 1477507531 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians

Taxonomy Code207RN0300X

License✔ Licensed in LA · 025644

Definition

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

927 E PRUDHOMME ST, Opelousas, LA 70570

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Other Identifiers 1

Medicaid04333LA

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 Magnolia Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Raphael John Higginbotham M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1355344276

PECOS Enrollment IDI20060815000385

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

611 services374 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

517 services134 patients

Dialysis services, 2-3 physician visits per month (20 years or older) 90961

Dialysis is a treatment that performs the function of healthy kidneys if they're not working properly. It removes waste and excess fluid from your blood. 2-3 physician visits per month are recommended for monitoring your health and adjusting your treatment as needed. This service is available for those aged 20 years and older.

205 services60 patients

Dialysis services, 4 or more physician visits per month (20 years or older) 90960

Dialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys can't do their job. This service includes 4 or more visits per month with a physician to monitor your health and adjust your treatment as needed.

178 services57 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

117 services98 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

72 services72 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ochsner Lafayette General Medical Center

Acute Care Hospitals · Lafayette, LA

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number190002

Location1214 Coolidge AvenueLafayette, LA 70503 · Lafayette County

Emergency services Birthing friendly

Opelousas General Health System

Acute Care Hospitals · Opelousas, LA

3/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number190017

Location539 East Prudhomme StreetOpelousas, LA 70570 · St. Landry County

Emergency services Birthing friendly

Our Lady Of Lourdes Regional Medical Center, Inc

Acute Care Hospitals · Lafayette, LA

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number190102

Location4801 Ambassador Caffery ParkwayLafayette, LA 70508 · Lafayette County

Emergency services Birthing friendly

Mercy Regional Medical Center

Acute Care Hospitals · Ville Platte, LA

3/5 CMS rating

OwnershipProprietary

CMS Certification Number190167

Location800 E MainVille Platte, LA 70586 · Evangeline County

Emergency services

Ochsner St Martin Hospital

Critical Access Hospitals · Breaux Bridge, LA

OwnershipVoluntary non-profit - Private

CMS Certification Number191302

Location210 Champagne BoulevardBreaux Bridge, LA 70517 · St. Martin County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 70570 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$124.60 typical visit price

range $53.43 – $164.73

Typical copayment $31.15 (range $13.35 – $41.18)

Most-billed visit code 99204

Established Patient

$95.09 typical visit price

range $16.64 – $133.62

Typical copayment $23.77 (range $4.16 – $33.40)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

60.64/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Individually scored

Quality

34.44

Improvement Activities

Cost

34.39

Reported Quality Measures

Advance Care Plan

4%606 patients1/55-star benchmark: 100%

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Lower rates are better for this measure.

86%229 patients1/55-star benchmark: 91%

Documentation of Current Medications in the Medical Record

94%1,460 patients3/55-star benchmark: 100%

Falls: Screening for Future Fall Risk

4%590 patients1/55-star benchmark: 100%

Functional Outcome Assessment

0%1,460 patients1/55-star benchmark: 100%

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

23%267 patients1/55-star benchmark: 100%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients combinedPopulations: 93% · 464 patients

Patients screened: 98% · 464 patients

12%26 patients1/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Tacrolimus, immediate release, oral, 1 mg J7507

Treatment-Treatment - Miscellaneous · category RX029N

6 suppliers39 claims2,730 services$0.29 avg. paid by Medicare

Cyclosporine, oral, 25 mg J7515

Treatment-Treatment - Miscellaneous · category RX029N

2 suppliers13 claims2,340 services$0.58 avg. paid by Medicare

Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period Q0511

Treatment-Chemotherapy · category RH012N

8 suppliers43 claims43 services$17.61 avg. paid by Medicare

Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period Q0512

Treatment-Chemotherapy · category RH012N

5 suppliers30 claims31 services$11.78 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KIDNEY TREATMENT OPTIONS CENTER OF LAFAYETTE LLC

Internal Medicine (Nephrology)