NPIMap

Organization Active NPI

David Raines Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
National Provider Identifier
1104249473
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Practice address
3021 W 70TH St
Shreveport, LA 71108-4603
Phone
(318) 227-3350
NPI assigned
Jan 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Authorized official

Name
Mr. Willie White III
Title
Ceo
Phone
(318) 227-3350

Specialties & licenses 1

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

Addresses

Primary practice location

3021 W 70TH St
Shreveport, LA 71108-4603

Mailing address

3041 Dr Martin Luther King Dr
Shreveport, LA 71107-4705
Phone (318) 227-3350

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041007000508 LA Part B Supplier - Clinic/Group Practice 4688586118 Receives reassigned benefits from 67 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gilliam, LA; Shreveport, LA; Minden, LA; Keithville, LA; Hayneville, LA; Bossier City, LA
O20140304000086 LA Part A Provider - Federally Qualified Health Center (FQHC) 4688586118 Practice locations: Shreveport, LA

Federally qualified health center certification: CCN 191911

Legal name
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Doing business as
DAVID RAINES COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 4, 2014
Last certification
Mar 4, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 1992 in LA
Enrollment address
3021W 70TH St
Shreveport, LA 71108-4603

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 20

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

View all 20

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
19D2074444David Raines Community Health Centers3021 West 70TH Street, Shreveport, LA 71108Certificate of waiverApr 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
David Raines Community Health Center26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1625 David Raines Rd
Shreveport, LA 71107
Phone (318) 425-2252

1327 Pierre Ave
Shreveport, LA 71103
Phone (318) 212-8624

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Darrell Webb Individual Corporate OfficerBoard Jan 1, 2026
Gladys Bush Individual Corporate OfficerTreasurer Jan 1, 2026
Deeandriez Wallace Individual Corporate OfficerBoard Mar 1, 2022
Stephen F Wright Individual Corporate OfficerBoard Member Mar 1, 2022
Fredrick Wilson Individual Corporate OfficerBoard Mar 1, 2022
Kenya Roberts Individual Corporate OfficerBoard Jan 1, 2026
Willie C White Individual Corporate OfficerCeo May 17, 1997
W-2 Managing EmployeeCeo May 17, 1997
Operational/Managerial ControlCeo May 17, 1997
Todd Hollenshead Individual Corporate OfficerVice President Mar 1, 2022
Myrtis Edwards Individual Corporate DirectorCoo Nov 6, 2001
W-2 Managing EmployeeCoo Nov 6, 2001
Janice Sneed Individual Corporate OfficerBoard Jan 1, 2026
Ryan Williams Individual Corporate OfficerSecretary Mar 1, 2022

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390348800000",
    "number": "1104249473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 DR MARTIN LUTHER KING DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711074705",
            "telephone_number": "318-227-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 W 70TH ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711084603",
            "telephone_number": "318-227-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID RAINES COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2014-01-22",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-227-3350",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.