NPIMap

Organization Active NPI

CLHG-Acadian LLC

Doing business as Church Point Medical Clinic by AMC

  • Rural Health Clinic/Center
  • Church Point, LA
National Provider Identifier
1043936164
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-ACADIAN LLC
Doing business as
Church Point Medical Clinic by AMC
Practice address
731 S Main St Ste a
Church Point, LA 70525-4109
Phone
(337) 580-7500
NPI assigned
Oct 19, 2022
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Kevin F Frank
Title
Ceo
Phone
(337) 580-7504

Specialties & licenses 1

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

Addresses

Primary practice location

731 S Main St Ste a
Church Point, LA 70525-4109

Mailing address

731 S Main St Ste a
Church Point, LA 70525-4109

Other names 1

  • Church Point Medical Clinic by AMC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220308002570 LA Part B Supplier - Clinic/Group Practice 0840521209 Receives reassigned benefits from 83 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Church Point, LA; Eunice, LA
O20230214002640 LA Part A Provider - Rural Health Clinic 0840521209 Practice locations: Church Point, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043936164. Details of each certification follow.

Rural health clinic certification: CCN 198548

Legal name
CLHG-ACADIAN LLC
Doing business as
CHURCH POINT MEDICAL CLINIC BY AMC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 14, 2024
Last certification
Feb 14, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Aug 5, 2016 in LA
Enrollment address
731 S Main St
Ste a
Church Point, LA 70525-4109
Related CCNs
190318

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Acadian LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Donald Cameron Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2020 16%
Corporate Officer Sep 1, 2020
Corporate Director Sep 1, 2020
Operational/Managerial Control Sep 1, 2020
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Sep 1, 2020 80%
Corporate OfficerCeo Sep 1, 2020
Operational/Managerial Control Sep 1, 2020
David Ingram Individual Corporate DirectorCeo Aug 1, 2024
W-2 Managing Employee Aug 1, 2024
Cameron Investments LLC Organization, Shreveport, LA LLC 5% Or Greater Direct Ownership Interest Feb 1, 2023 16%

Facilities with the same owner 43

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

View all 43

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1043936164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 S MAIN ST STE A",
            "city": "CHURCH POINT",
            "state": "LA",
            "postal_code": "705254109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 S MAIN ST STE A",
            "city": "CHURCH POINT",
            "state": "LA",
            "postal_code": "705254109",
            "telephone_number": "337-580-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-ACADIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-19",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "FRANK",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-580-7504"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Church Point Medical Clinic by AMC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Church Point Medical Clinic by AMC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Church Point, LA

Sources for this page

Verify at the official NPI Registry.