NPIMap

Organization Active NPI

Bastrop Rehabilitation Hospital, LLC

Doing business as South Ouachita Clinic

  • Rural Health Clinic/Center
  • Monroe, LA
National Provider Identifier
1033618616
Registry record updated Feb 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BASTROP REHABILITATION HOSPITAL, LLC
Doing business as
South Ouachita Clinic
Practice address
4310 S Grand St Ste 1
Monroe, LA 71202-6322
Phone
(318) 746-0420
Fax
(318) 752-1940
NPI assigned
Feb 8, 2018
Last updated
Feb 8, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
BASTROP REHABILITATION HOSPITAL, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 8, 2018

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

Authorized official

Name
William Means
Title
Administrator
Phone
(318) 746-0420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

4310 S Grand St Ste 1
Monroe, LA 71202-6322

Mailing address

816 Benton Rd
Bossier City, LA 71111-3744
Phone (318) 243-5533

Other identifiers 1

IdentifierTypeStateIssuer
1700517MedicaidLA

Other names 1

  • South Ouachita Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180523000181 LA Part A Provider - Rural Health Clinic 8123096641 Practice locations: Monroe, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033618616. Details of each certification follow.

Rural health clinic certification: CCN 198506

Legal name
BASTROP REHABILITATION HOSPITAL, LLC
Doing business as
SOUTH OUACHITA CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 21, 2018
Last certification
Nov 21, 2024
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Sep 20, 1999 in LA
Enrollment address
4310 S Grand St
Ste 1
Monroe, LA 71202-6322
Related CCNs
193058

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Part of
Bastrop Rehab Hosp LLC

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Prestige Ventures LLC Organization, Baton Rouge, LA LLC, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2010 48%
William Means Individual Corporate OfficerAdministrator Board Member Jan 1, 2010
Operational/Managerial ControlAdministrator Board Member Jan 1, 2010
Walter Bigby Individual 5% Or Greater Indirect Ownership Interest Sep 20, 1999 52%
Corporate OfficerBoard Member Sep 20, 1999
Operational/Managerial ControlBoard Member Sep 20, 1999
Noble Javier Means Individual 5% Or Greater Indirect Ownership Interest Feb 14, 2014 8%
Anrand LLC Organization, Bossier City, LA LLC, For-profit 5% Or Greater Indirect Ownership Interest Dec 15, 2014 24%
Wellness Enterprises, LLC Organization, Bossier City, LA LLC, Non-profit 5% Or Greater Direct Ownership Interest Sep 20, 1999 100%
Operational/Managerial Control Sep 20, 1999
Alexander Blondeau Individual 5% Or Greater Indirect Ownership Interest Jan 10, 2010 24%
Anastasia M Means Individual 5% Or Greater Indirect Ownership Interest Feb 14, 2014 8%
William R Means Individual 5% Or Greater Indirect Ownership Interest Feb 14, 2014 8%
Kyle Jacob Individual Corporate OfficerAssistant Administrator/Board Me May 10, 2018
W-2 Managing EmployeeAssistant Administrator/Board Me May 10, 2018
Operational/Managerial ControlAssistant Administrator/Board Me May 10, 2018

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518048000000",
    "number": "1033618616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 BENTON RD",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113744",
            "telephone_number": "318-243-5533",
            "fax_number": "318-752-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 S GRAND ST STE 1",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712026322",
            "telephone_number": "318-746-0420",
            "fax_number": "318-752-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASTROP REHABILITATION HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BASTROP REHABILITATION HOSPITAL, LLC",
        "enumeration_date": "2018-02-08",
        "last_updated": "2018-02-08",
        "status": "A",
        "authorized_official_last_name": "MEANS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-746-0420"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700517",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Ouachita Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.