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CARL M GAUTHIER JR. M.D.
NPI 1649460239
Internal Medicine - Rheumatology in Hammond, LA

Active since July 30, 2007PECOS EnrolledAccepts Medicare Assignment
79.02/100
CMS Quality Rating
15813 PAUL VEGA MD DR STE 400, HAMMOND, LA 70403(985) 230-1835(985) 230-1836 Get Directions Write a Review

NPPES record last updated: December 8, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Carl M Gauthier Jr. M.d. NPPES

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

CARL M GAUTHIER JR. M.D. (NPI 1649460239) is an individual rheumatology provider in Hammond, Louisiana, licensed in Louisiana (MD.201999) and active in the NPI registry since July 2007. He is enrolled in Medicare PECOS, is affiliated with North Oaks Medical Center, and is a graduate of Louisiana State University School Of Medicine In New Orleans (2006).

NPPES Registry Identity

NPI1649460239
Entity TypeIndividualMale
Primary Taxonomy207RR0500X
Provider Legal NameCARL M GAUTHIER JR.Credential: M.D.
Location Address15813 PAUL VEGA MD DR STE 400Hammond, LA 70403-1431
Mailing AddressPo Box 3087Hammond, LA 70404-3087 · (985) 230-1835 · Fax (985) 230-1836
Phone(985) 230-1835
Fax(985) 230-1836
Sole ProprietorNo
Medical School CMSLouisiana State University School Of Medicine In New OrleansGraduated 2006
Enumeration DateJuly 30, 2007
Last NPPES UpdateDecember 8, 2022
NPPES CertifiedDecember 8, 2022
✔ NPI 1649460239 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · RheumatologyAllopathic & Osteopathic Physicians
Taxonomy Code207RR0500X
License✔ Licensed in LA · MD.201999
Definition
An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.
15813 PAUL VEGA MD DR STE 400, Hammond, LA 70403
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Other Identifiers 1

Medicaid1077330LA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, HMO Louisiana.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

Carl M Gauthier Jr. 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 ID3971773490
PECOS Enrollment IDI20110818000891
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 5

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.
739 services341 patients
Aspiration and/or injection of fluid from large joint 20610
This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.
131 services57 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
43 services26 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.
23 services23 patients
Aspiration and/or injection of fluid from small joint 20600
This procedure involves inserting a thin needle into a small joint to remove (aspirate) or inject fluid. It can help diagnose conditions, relieve discomfort, or administer medication directly into the joint. It's generally safe with minimal discomfort.
16 services13 patients

Hospital Affiliations CMS Care Compare 5

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

North Oaks Medical Center

Acute Care Hospitals · Hammond, LA
2/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number190015
Location15790 Paul Vega MD DriveHammond, LA 70403 · Tangipahoa County
Emergency services Birthing friendly

Ochsner Medical Center Acute

Acute Care Hospitals · New Orleans, LA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number190036
Location1516 Jefferson HwyNew Orleans, LA 70121 · Jefferson County
Emergency services Birthing friendly

St Tammany Parish Hospital

Acute Care Hospitals · Covington, LA
4/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number190045
Location1202 S Tyler StreetCovington, LA 70433 · St. Tammany County
Emergency services Birthing friendly

St Helena Parish Hospital

Critical Access Hospitals · Greensburg, LA
OwnershipGovernment - Hospital District or Authority
CMS Certification Number191300
Location16874 Highway 43Greensburg, LA 70441 · St. Helena County
Emergency services

Riverside Medical Center

Critical Access Hospitals · Franklinton, LA
OwnershipGovernment - Hospital District or Authority
CMS Certification Number191313
Location1900 South Main StFranklinton, LA 70438 · Washington County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 70403 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.

79.02/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality74.5
Promoting Interoperability100
Improvement Activities40
Cost42.93

Referred Medical Equipment & Supplies CMS DME claims

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

Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds K0823
DME-Wheelchairs · category DD009N
1 supplier11 claims11 services$140.54 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Carl Gauthier's NPI number?

The NPI number for Carl Gauthier is 1649460239. It was assigned to this individual provider in the NPPES registry on July 30, 2007.

Where is Carl Gauthier located?

Carl Gauthier practices at 15813 Paul Vega MD Dr Ste 400, Hammond, LA 70403. The listed phone number is (985) 230-1835.

What is Carl Gauthier's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Rheumatology, with taxonomy code 207RR0500X.

Is Carl Gauthier enrolled in Medicare?

Yes. Carl Gauthier is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Carl Gauthier accept?

Health plans from Blue Cross and Blue Shield of Louisiana and HMO Louisiana list Carl Gauthier 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.

Is Carl Gauthier affiliated with any hospitals?

According to CMS data, Carl Gauthier is affiliated with North Oaks Medical Center, Ochsner Medical Center Acute, St Tammany Parish Hospital, St Helena Parish Hospital and Riverside Medical Center.

When was this NPI record last updated?

The NPPES record for Carl Gauthier was last updated on December 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.