NPIMap

Organization Active NPI

Headache and Wellness Center of Southwest Louisiana, LLC

  • Clinic/Center
  • Lake Charles, LA
National Provider Identifier
1043814486
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
HEADACHE AND WELLNESS CENTER OF SOUTHWEST LOUISIANA, LLC
Practice address
803 W Bayou Pines Dr Ste B
Lake Charles, LA 70601-7096
Phone
(337) 508-2333
NPI assigned
Nov 25, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Mrs. Darci L Portie, NPNPI 1033592886
Title
Owner
Phone
(337) 508-2333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

803 W Bayou Pines Dr Ste B
Lake Charles, LA 70601-7096

Mailing address

803 W Bayou Pines Dr Ste B
Lake Charles, LA 70601-7096
Phone (337) 508-2333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210215000283 LA Part B Supplier - Clinic/Group Practice 9931514494 Receives reassigned benefits from 1 practitioner
Practice locations: Lake Charles, LA

National Provider Directory

National Provider Directory

Locations

803 W Bayou Pines Dr
Ste B
Lake Charles, LA 70601
Phone (337) 274-9034

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1606262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1043814486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 W BAYOU PINES DR STE B",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017096",
            "telephone_number": "337-508-2333",
            "fax_number": "337-549-6316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 W BAYOU PINES DR STE B",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017096",
            "telephone_number": "337-508-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEADACHE AND WELLNESS CENTER OF SOUTHWEST LOUISIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-25",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "PORTIE",
        "authorized_official_first_name": "DARCI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-508-2333",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.