NPIMap

Organization Active NPI

HIV-AIDS Alliance for Region Two

Doing business as Open Health Care Clinic

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
National Provider Identifier
1083350888
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HIV-AIDS ALLIANCE FOR REGION TWO
Doing business as
Open Health Care Clinic
Practice address
781 Colonial Dr
Baton Rouge, LA 70806-6512
Phone
(225) 655-6422
Fax
(225) 341-5903
NPI assigned
May 5, 2022
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Authorized official

Name
Tim Young
Title
President & Chief Executive Officer
Phone
(225) 424-1800

Specialties & licenses 1

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

Addresses

Primary practice location

781 Colonial Dr
Baton Rouge, LA 70806-6512

Mailing address

9516 Airline Hwy
Baton Rouge, LA 70815-5501
Phone (225) 655-6422

Other names 1

  • Open Health Care Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181101000702 LA Part B Supplier - Clinic/Group Practice 4880981158 Receives reassigned benefits from 38 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA; Eunice, LA; Denham Springs, LA
O20220819001622 LA Part A Provider - Federally Qualified Health Center (FQHC) 4880981158 Practice locations: Baton Rouge, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083350888. Details of each certification follow.

Federally qualified health center certification: CCN 191107

Legal name
HIV-AIDS ALLIANCE FOR REGION TWO
Doing business as
OPEN HEALTH CARE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 15, 2022
Last certification
Aug 15, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 16, 1995 in LA
Enrollment address
781 Colonial Dr
Baton Rouge, LA 70806-6512

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Hivaids Alliance for Region Two Inc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

4550 North Blvd
Ste 250
Baton Rouge, LA 70806
Phone (225) 927-1269

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
Cassandra Whitty Individual Corporate OfficerBoard Member May 1, 2007
Bryan Jeansonne Individual Corporate OfficerBoard Member Jun 1, 2022
Cody King Individual Corporate OfficerBoard Member May 1, 2015
Benjamin N Levron Individual Corporate OfficerBoard Member Oct 1, 2020
Maria Pons Individual Corporate OfficerBoard Member Jun 1, 2021
Billy Dudley Individual Corporate OfficerBoard Chairman Jun 1, 2015
HIV-AIDS Alliance for Region Two Organization, Baton Rouge, LA Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2022 100%
Harry Dunston Individual Corporate OfficerBoard Member Oct 1, 2021
Timothy Young Individual Corporate DirectorChief Executive Officer Sep 1, 1996
Dawn Beasley Individual W-2 Managing EmployeeChief Operating Officer Oct 1, 2015
Pamala Ellis Individual Corporate OfficerBoard Quality Chair Aug 1, 2004
Sherry Lassere Individual Corporate OfficerBoard Member Oct 1, 2016
Matthew Walton Individual Corporate OfficerBoard Member Apr 1, 2023
Walthena Gosa Individual Corporate OfficerBoard Member Apr 1, 2023

Owners & managing parties with NPI records 14

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

View all 14

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Open Health Care ClinicBaton Rouge, LA, CCN 191955 Federally qualified health center 5% Or Greater Indirect Ownership Interest Jan 1, 2017
Open Health Care ClinicBaton Rouge, LA, CCN 191050 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Jun 1, 2020
Open Health Care ClinicDenham Springs, LA, CCN 191088 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Open Health Care ClinicEunice, LA, CCN 191154 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Sep 25, 2023
Open Health Care ClinicBaton Rouge, LA, CCN 191177 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 28, 2023
Open Health Care ClinicBaton Rouge, LA, CCN 191176 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Jan 19, 2024
Open Health Care ClinicBaton Rouge, LA, CCN 711976 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Aug 14, 2025

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1651708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1083350888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9516 AIRLINE HWY",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708155501",
            "telephone_number": "225-655-6422",
            "fax_number": "225-341-5903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 COLONIAL DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708066512",
            "telephone_number": "225-655-6422",
            "fax_number": "225-341-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIV-AIDS ALLIANCE FOR REGION TWO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-05",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "225-424-1800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Open Health Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Open Health Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.