NPIMap

Organization Active NPI

Marillac Community Health Centers

Doing business as DePaul Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Metairie, LA
National Provider Identifier
1053089110
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARILLAC COMMUNITY HEALTH CENTERS
Doing business as
DePaul Community Health Centers
Practice address
3116 6TH St Ste 101
Metairie, LA 70002-1762
Phone
(504) 837-9000
Fax
(504) 837-8293
NPI assigned
Sep 2, 2021
Last updated
May 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Michael Griffin
Title
President/Ceo
Phone
(504) 207-3060

Specialties & licenses 1

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

Addresses

Primary practice location

3116 6TH St Ste 101
Metairie, LA 70002-1762

Mailing address

PO Box 13038
New Orleans, LA 70185-3038

Other names 1

  • DePaul Community Health Centers Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110314000767 LA Part B Supplier - Clinic/Group Practice 3678755535 Receives reassigned benefits from 128 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenner, LA; New Orleans, LA; Metairie, LA; Harvey, LA
O20250113001099 LA Part A Provider - Federally Qualified Health Center (FQHC) 3678755535 Practice locations: Metairie, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053089110. Details of each certification follow.

Federally qualified health center certification: CCN 711006

Legal name
MARILLAC COMMUNITY HEALTH CENTERS
Doing business as
DEPAUL COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 2, 2025
Last certification
Jan 2, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3116 6TH St
Ste 101
Metairie, LA 70002-1762

Other NPIs on the same Medicare enrollment 21

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

View all 21

National Provider Directory

National Provider Directory
Tax ID family
Marillac Comm HLTH Centers70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

Locations

3116 6th St
Metairie, LA 70002

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Ellen Kron Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Wendy Rios-Wood Individual W-2 Managing EmployeeCredentialing Specialist Jan 1, 2024
Michael Deyoung Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Roderic Teamer Individual Operational/Managerial ControlBoard Chair Jan 1, 2024
Ronald Carrere Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Sarah Moody-Thomas Individual Operational/Managerial Control Jan 1, 2024
Flori Hicks Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Stephanie Navarre Individual Operational/Managerial ControlBoard Vice Chair Jan 1, 2024
Marjorie Hebert Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Catherine Kelly Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Anna Garner Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Michael Griffin Individual W-2 Managing EmployeeAd; Jan 1, 2024
Robert Angelico Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Jedidah Jackson Individual Operational/Managerial Control Jan 1, 2024

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Depaul Community Health CentersNew Orleans, LA, CCN 191974 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 15, 2010

Practitioners & affiliated clinicians

Practitioners 12

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": "1630540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1053089110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13038",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701853038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 6TH ST STE 101",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700021762",
            "telephone_number": "504-837-9000",
            "fax_number": "504-837-8293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILLAC COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-02",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "504-207-3060"
    },
    "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": "DePaul Community Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DePaul Community Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Metairie, LA

Sources for this page

Verify at the official NPI Registry.