NPIMap

Organization Active NPI

Primary Health Services Center

Doing business as PHSC DeSiard Street Clinic

  • Federally Qualified Health Center (FQHC)
  • Monroe, LA
National Provider Identifier
1043315286
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY HEALTH SERVICES CENTER
Doing business as
PHSC DeSiard Street Clinic
Practice address
2913 Desiard St
Monroe, LA 71201-7207
Phone
(318) 651-9914
Fax
(318) 410-0688
NPI assigned
Sep 13, 2006
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
Mrs. Catherine M Tonore
Title
Ceo
Phone
(318) 388-1250

Specialties & licenses 1

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

Addresses

Primary practice location

2913 Desiard St
Monroe, LA 71201-7207

Mailing address

PO Box 7495
Monroe, LA 71211-7495
Phone (318) 388-1250

Other names 1

  • PHSC DeSiard Street Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040304000762 LA Part A Provider - Federally Qualified Health Center (FQHC) 2062300858 Practice locations: Monroe, LA
O20051110000010 LA Part B Supplier - Clinic/Group Practice 2062300858 Receives reassigned benefits from 29 practitioners
5 other NPIs on this enrollment
Practice locations: Grambling, LA; Monroe, LA; West Monroe, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043315286. Details of each certification follow.

Federally qualified health center certification: CCN 191830

Legal name
PRIMARY HEALTH SERVICES CENTER
Doing business as
PRIMARY HEALTH SERVICES CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 6, 2001
Last certification
Mar 6, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 19, 1997 in LA
Enrollment address
2913 Desiard St
Monroe, LA 71201-7207
Related CCNs
191828

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

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
Willie Robinson Individual Corporate DirectorBoard Member Jan 1, 2012 10%
Cathy Holmes-Giles Individual Corporate DirectorBoard Member Feb 1, 2017 10%
Sallie M Evans Individual Corporate DirectorBoard Member Apr 1, 2019 10%
Betty Bullock Individual Corporate DirectorBoard Member Apr 1, 2015 10%
Sandra Daigre Individual Corporate DirectorBoard Member Mar 1, 2016 10%
Shelia Riley Individual Corporate DirectorBoard Member Dec 1, 2019 10%
Vanessa Johnson Individual Corporate DirectorBoard Member Jan 1, 2012 10%
Leon Smith Individual Corporate DirectorBoard Member Mar 1, 2017 10%
Bertha Williams Individual Corporate DirectorBoard Member Jan 1, 2012 10%
Catherine M Tonore Individual Corporate OfficerCeo Jan 1, 1999 10%
W-2 Managing EmployeeCeo Jan 1, 1999

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
We Care Health ClinicMonroe, LA, CCN 191838 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2002
Primary Health Services Center- Women Health and Pediatric ClinicMonroe, LA, CCN 191901 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2012
Nov 1, 2012
PHSC- Grambling Family Health CenterGrambling, LA, CCN 191969 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 19, 2017
PHSC West Monroe Family Health CenterWest Monroe, LA, CCN 191013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 28, 2019
Primary Health Services CenterMonroe, LA, CCN 191142 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 21, 2023

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1043315286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7495",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712117495",
            "telephone_number": "318-388-1250",
            "fax_number": "318-388-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2913 DESIARD ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017207",
            "telephone_number": "318-651-9914",
            "fax_number": "318-410-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH SERVICES CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "TONORE",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-388-1250",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHSC DeSiard Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.