NPIMap

Organization Active NPI

Desoto Regional Family Medicine

Doing business as DeSoto Regional Family Medicine - Mansfield

  • Rural Health Clinic/Center
  • Mansfield, LA
National Provider Identifier
1043359839
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DESOTO REGIONAL FAMILY MEDICINE
Doing business as
DeSoto Regional Family Medicine - Mansfield
Practice address
130 Jefferson St
Mansfield, LA 71052-2602
Phone
(318) 872-2700
Fax
(318) 872-6214
NPI assigned
Feb 6, 2007
Last updated
Mar 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Authorized official

Name
Hallie Deutsch
Title
Credentialing Specialist
Phone
(318) 871-3101

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X LA
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

130 Jefferson St
Mansfield, LA 71052-2602

Mailing address

130 Jefferson St
Mansfield, LA 71052-2602
Phone (318) 872-2700

Other identifiers 2

IdentifierTypeStateIssuer
CN5547OtherLARR MEDICARE
1948357MedicaidLA

Other names 1

  • DeSoto Regional Family Medicine - Mansfield Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412001175 LA Part B Supplier - Clinic/Group Practice 7719970599 Receives reassigned benefits from 18 practitioners
Practice locations: Mansfield, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FEDHAA

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1043359839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 JEFFERSON ST",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "710522602",
            "telephone_number": "318-872-2700",
            "fax_number": "318-872-6214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 JEFFERSON ST",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "710522602",
            "telephone_number": "318-872-2700",
            "fax_number": "318-872-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO REGIONAL FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "DEUTSCH",
        "authorized_official_first_name": "HALLIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "318-871-3101"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CN5547",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1948357",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeSoto Regional Family Medicine - Mansfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.