NPIMap

Organization Active NPI

Riverside Medical Center

Doing business as Riverside Surgical Clinic

  • Clinic/Center
  • Franklinton, LA
National Provider Identifier
1104290949
Registry record updated Sep 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
RIVERSIDE MEDICAL CENTER
Doing business as
Riverside Surgical Clinic
Practice address
809 Riverside Dr
Franklinton, LA 70438-3635
Phone
(985) 795-4208
Fax
(985) 795-4210
NPI assigned
Nov 17, 2015
Last updated
Sep 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2022

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

Authorized official

Name
Stacey K McGraw
Title
Business Office Director
Phone
(985) 795-4168

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Surgery Physician 208600000X 168 LA

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 1

  • Riverside Surgical 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
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104290949. Details of each certification follow.

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
OtherNon-profit
Enrollment address
1900 Main Street
Franklinton, LA 70438-3688
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 7

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Riverside Medical CenterCCN 191313 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Riverside Medical Cente8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

809 Riverside Dr
Franklinton, LA 70438
Phone (985) 795-4208

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
James Thomas Individual Corporate OfficerBoard of Commissioners Sep 1, 1995
Pamela Breland Individual Corporate OfficerBoard of Commissioners May 1, 2013
Malcolm Wascom Individual Corporate OfficerBoard of Commissioners Jan 1, 2021
Jimmy Seibert Individual W-2 Managing EmployeeAd; Jun 1, 2025 100%
Patricia Mizell Individual W-2 Managing EmployeeChief Financial Officer Feb 7, 2025 100%
Riverside Medical Center Organization, Franklinton, LA 5% Or Greater Direct Ownership Interest Jul 2, 2004
Robin D Fabre Individual Corporate OfficerBoard of Commissioners Jul 31, 2023
Cynthia August Individual Corporate OfficerBoard of Commissioners Jan 1, 2023
Lori Schilling Individual Corporate OfficerBoard of Commissioners Feb 1, 2017
Tammy Magruder Individual Corporate OfficerBoard of Commisioners Nov 1, 2016
Randy Magee Individual Corporate OfficerBoard of Commissioners Jun 1, 2022
Grayson Ball Individual Corporate OfficerBoard of Commissioners Jan 1, 2023
Arthur E Westbrook Jr Individual Corporate OfficerBoard of Commissioners Jan 1, 2023

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 189

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 189

NPI Registry JSON

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1104290949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 RIVERSIDE DR",
            "city": "FRANKLINTON",
            "state": "LA",
            "postal_code": "704383635",
            "telephone_number": "985-795-4208",
            "fax_number": "985-795-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 RIVERSIDE DR",
            "city": "FRANKLINTON",
            "state": "LA",
            "postal_code": "704383635",
            "telephone_number": "985-795-4208",
            "fax_number": "985-795-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-17",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "MCGRAW",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "985-795-4168"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "168",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Surgical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Riverside Surgical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Franklinton, LA

Sources for this page

Verify at the official NPI Registry.