NPIMap

Organization Active NPI

Southeast Community Health Systems

  • Federally Qualified Health Center (FQHC)
  • Kentwood, LA
National Provider Identifier
1013468909
Registry record updated Oct 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Practice address
603 9TH St
Kentwood, LA 70444-2317
Phone
(985) 514-2085
NPI assigned
Oct 17, 2016
Last updated
Oct 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alecia Cyprian, PHD
Title
Ceo
Phone
(225) 306-2010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

603 9TH St
Kentwood, LA 70444-2317

Mailing address

PO Box 770
Zachary, LA 70791-0770
Phone (225) 306-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250206000244 LA Part A Provider - Federally Qualified Health Center (FQHC) 4284610437 Practice locations: Kentwood, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013468909. Details of each certification follow.

Federally qualified health center certification: CCN 711035

Legal name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Doing business as
SOUTHEAST COMMUNITY HEALTH SYSTEMS - KENTWOOD HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 29, 2025
Last certification
Jan 29, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
603 9TH St
Kentwood, LA 70444-2317

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

National Provider Directory

National Provider Directory
Tax ID family
SE Community Health Systems37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Terry Addison Individual Corporate OfficerBoard Member Sep 1, 2016
Mira L Robertson Individual Corporate OfficerBoard Member Sep 1, 2016
Rochell Bates Individual Corporate OfficerBoard Member Sep 1, 2016
Major Coleman Individual Corporate OfficerBoard Member Sep 1, 2016
Margaret Smith Individual Corporate OfficerBoard Member Sep 1, 2016
Michael Martin Individual Corporate OfficerBoard Vice Chair Sep 1, 2016
Alecia Cyprian Individual W-2 Managing EmployeeAd; Sep 1, 2016
Virginia Reeves Foster Individual W-2 Managing EmployeeCredentialing Specialist Sep 1, 2016
Paula McNabb Individual Corporate OfficerBoard Member Sep 1, 2016
Reyna E Lopez Individual Corporate OfficerBoard Member Sep 1, 2016
Sandy K Tillery Individual Corporate OfficerBoard Member Sep 1, 2016
Dameon Jackson Individual Corporate OfficerBoard Chair Sep 1, 2016

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
KentwoodKentwood, LA, CCN 191841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
AlbanyHammond, LA, CCN 191895 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013
IndependenceIndependence, LA, CCN 191918 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
WMGHammond, LA, CCN 191965 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2008

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1013468909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707910770",
            "telephone_number": "225-306-2000",
            "fax_number": "225-658-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 9TH ST",
            "city": "KENTWOOD",
            "state": "LA",
            "postal_code": "704442317",
            "telephone_number": "985-514-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COMMUNITY HEALTH SYSTEMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "CYPRIAN",
        "authorized_official_first_name": "ALECIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-306-2010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, LA

Sources for this page

Verify at the official NPI Registry.