NPIMap

Organization Active NPI

Clinics of the Southeast LLC

Doing business as Bogalusa Family Medicine & Behavioral Health

  • Rural Health Clinic/Center
  • Bogalusa, LA
National Provider Identifier
1053082743
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLINICS OF THE SOUTHEAST LLC
Doing business as
Bogalusa Family Medicine & Behavioral Health
Practice address
219 S Border Dr
Bogalusa, LA 70427-3671
Phone
(985) 732-1568
NPI assigned
Sep 23, 2021
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CLINIC OF THE SOUTHEAST LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Anthony Jude PalazzoNPI 1063457554
Title
Ceo
Phone
(985) 735-7707

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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

219 S Border Dr
Bogalusa, LA 70427-3671

Mailing address

PO Box 370
Bogalusa, LA 70429-0370
Phone (985) 732-1568

Other names 1

  • Bogalusa Family Medicine & Behavioral Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210608001420 LA Part B Supplier - Clinic/Group Practice 6709116239 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bogalusa, LA
O20211006002625 LA Part A Provider - Rural Health Clinic 6709116239 Practice locations: Bogalusa, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053082743. Details of each certification follow.

Rural health clinic certification: CCN 198911

Legal name
CLINICS OF THE SOUTHEAST LLC
Doing business as
BOGALUSA FAMILY MEDICINE & BEHAVIORAL HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 30, 2022
Last certification
Aug 30, 2022
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 23, 2019 in LA
Enrollment address
219 S Border Dr
Bogalusa, LA 70427-3671

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2253610Bogalusa Family Medicine & Behavioral Health219 S Border Dr, Bogalusa, LA 70427Certificate of waiverFeb 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Clinics of the Southeast LLC2 organizations share this tax ID, including this one
Part of
Clinics of the Southeast LLC

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Anthony J Palazzo Individual 5% Or Greater Direct Ownership InterestCeo Apr 23, 2019 95%
General Partnership InterestCeo Apr 23, 2019 95%
Corporate OfficerCeo Apr 23, 2019 95%
Operational/Managerial ControlCeo Apr 23, 2019 95%
Celia Palazzo Individual 5% Or Greater Direct Ownership Interest Apr 23, 2019 5%
General Partnership InterestPresident Apr 23, 2019 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Anthony Jude Palazzo, M.D.
    • Pediatric Adolescent Medicine Physician
    • Bogalusa, LA
    • NPI 1063457554

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

    CMS ownership

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 5

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": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1053082743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704290370",
            "telephone_number": "985-732-1568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 S BORDER DR",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704273671",
            "telephone_number": "985-732-1568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICS OF THE SOUTHEAST LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINIC OF THE SOUTHEAST LLC",
        "enumeration_date": "2021-09-23",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "PALAZZO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "985-735-7707"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bogalusa Family Medicine & Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bogalusa, LA

Sources for this page

Verify at the official NPI Registry.