Riverside Medical Center
Organization Active NPI Clinic/Center · Franklinton, LA
NPI 1104290949 · NPPES record last updated Sep 19, 2022
Key facts
- NPI
- 1104290949
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- RIVERSIDE MEDICAL CENTER
- Practice address
- 809 Riverside Dr
Franklinton, LA 70438-3635 - Phone
- (985) 795-4208
- Fax
- (985) 795-4210
- NPI assigned
- Nov 17, 2015
- Organization subpart
- No
Authorized official
- Name
- Stacey K McGraw
- Title
- Business Office Director
- Phone
- (985) 795-4168
Owners & managing parties with NPI records 6
-
Robin Dees Fabre, M.D.
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 7
Related certifications (CCN) 2
Practitioners 4
-
Lisa Brooks, CRNA
-
Robin Dees Fabre, M.D.
-
Yasheka Nicholson, M.D
Affiliated clinicians 189
-
Farhad X Aduli, MD
-
Lucas Ainsworth, M.D.
-
Tracy T Aljabi, FNP
-
Luis M Alvarado, M.D.
-
Ali M Amkieh, M.D.
-
Tiger Arukwe, APRN, FNP-BC
-
Charles Balette, M.D.
-
Caroline Barkerding, FNP
-
Brandon K Bean, MD
-
Michael J Becker, MD
-
Lane Bell, FNP
-
Camille Nasim Bitar, M.D.
-
Ricardo E. Blanco, M.D.
-
Dennis Joseph Booth, M.D.
-
Thomas Edward Bowden Jr., M.D.
-
Tiffanie Boyce, PA
-
Andrew Bragagnini, PA-C
-
Patricia S Braly, MD
-
Ruffin Chase Branch, PA-C
Medicare Care Compare: Hospital
- Listed as
- Riverside Medical Center
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Hospital certification: CCN 191313
- Legal name
- RIVERSIDE MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Jul 2, 2004
- Last certification
- Nov 2, 2024
- Beds
- 25
- Ownership / control type
- Hospital district or authority
- Organization structure
- Other · Non-profit
- Enrollment address
- 1900 Main Street
Franklinton, LA 70438-3688
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| James Thomas |
Corporate Officer |
Sep 1, 1995 | |
| Pamela Breland |
Corporate Officer |
May 1, 2013 | |
| Malcolm Wascom |
Corporate Officer |
Jan 1, 2021 | |
| Jimmy Seibert |
W-2 Managing Employee |
Jun 1, 2025 | 100% |
| Patricia Mizell |
W-2 Managing Employee |
Feb 7, 2025 | 100% |
| Riverside Medical Center |
5% Or Greater Direct Ownership Interest | Jul 2, 2004 | |
| Robin D Fabre |
Corporate Officer |
Jul 31, 2023 | |
| Cynthia August |
Corporate Officer |
Jan 1, 2023 | |
| Lori Schilling |
Corporate Officer |
Feb 1, 2017 | |
| Tammy Magruder |
Corporate Officer |
Nov 1, 2016 | |
| Randy Magee |
Corporate Officer |
Jun 1, 2022 | |
| Grayson Ball |
Corporate Officer |
Jan 1, 2023 | |
| Arthur E Westbrook Jr |
Corporate Officer |
Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407000623 | LA | Part B Supplier - Clinic/Group Practice | 3173430196 |
Receives reassigned benefits from 18 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Franklinton, LA |
| O20151230002124 | LA | Part a Provider - Critical Access Hospital | 3173430196 |
Receives reassigned benefits from 12 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Franklinton, LA |
National Provider Directory
- Tax ID family
- Riverside Medical Cente
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | 168 | LA | |
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
809 Riverside Dr
Franklinton, LA 70438-3635
Mailing address
809 Riverside Dr
Franklinton, LA 70438-3635
Phone (985) 795-4208
Other names
- Riverside Surgical Clinic
Other providers in Franklinton, LA
- Stacey Richardson
- Katie Ritchie
- Riverside Medical Center
- Riverside Medical Center
- Riverside Medical Center
- Riverside Medical Center
- Riverside Medical Center
- Riverside Medical Center
- Riverside Medical Center
- Riverside Medical Center
All providers in Franklinton, LA · Clinic/Center in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.