Ville Platte Pediatrics PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

193914 Issued in LA

Legal business name

VILLE PLATTE PEDIATRICS PA

Practice address

504 Jack Miller Road
Suite 3
Ville Platte, LA 70586

Phone

(337) 363-3560

Fax

(337) 363-3507

NPI assigned

Sep 7, 2006

Organization subpart

No

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

Authorized official

Name

Dodanim Francisco AltamiranoNPI 1972598712

Title

MD

Phone

(337) 363-3560

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Ville Platte Pediatrics Corp Other name

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114020542. Details of each certification follow.

• CCN 193914 Rural health clinic · Active · Details

Rural health clinic certification: CCN 193914

Legal name

VILLE PLATTE PEDIATRICS PA

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 30, 2014

Last certification

Jul 30, 2023

Ownership / control type

1B

Most recent change of ownership

Jan 1, 2022 (1 total)

Organization structure

CorporationProprietary

Incorporated

Apr 11, 2006 in LA

Enrollment address

504 Jack Miller Rd, Suite 3
Ville Platte, LA 70586-5600

Tax ID family

Ville Platte Pediatric Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Ville Platte Pediatrics

  • Rural Health Clinic/Center
  • Ville Platte, LA
  • NPI 1306181698
  NPD tax ID

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

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

• Courtney Duplechin Manuel, FNP

  • Family Nurse Practitioner
  • Ville Platte, LA
  • NPI 1699117036

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

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.

• Dodanim Francisco Altamirano, MD

  • Pediatrics Physician
  • Ville Platte, LA
  • NPI 1972598712
  Medicare reassignment NPD Authorized official
• Courtney Duplechin Manuel, FNP

  • Family Nurse Practitioner
  • Ville Platte, LA
  • NPI 1699117036
  Medicare reassignment NPD

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1114020542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 JACK MILLER ROAD",
            "address_2": "SUITE 3",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "70586",
            "telephone_number": "337-363-3560",
            "fax_number": "337-363-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 JACK MILLER ROAD",
            "address_2": "SUITE 3",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "70586",
            "telephone_number": "337-363-3560",
            "fax_number": "337-363-3507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLE PLATTE PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2023-03-07",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "ALTAMIRANO",
        "authorized_official_first_name": "DODANIM",
        "authorized_official_middle_name": "FRANCISCO",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "337-363-3560"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "11525R",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "193914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED DANG SUB",
            "identifier": "241402006",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1671177",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ville Platte Pediatrics Corp",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ville Platte Pediatrics Corp",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Steven B Vidrine, MD
• Vigilant Healthcare-Southwest, LLC
• Ville Platte Medical Center
• Ville Platte Medical Center
• Ville Platte Pediatrics
• Visionaries Impacting People, LLC
• Vital Healthcare Solutions LLC (Magnolia Therapeutics)
• VP Family Pharmacy LLC (Ville Platte Clinic Pharmacy)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0312)
• Renee Walden, 5/11/1SLP

• Rural Health Clinic/Center in Ville Platte, LA
• Providers in Ville Platte, LA by specialty
• Rural Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.