NPIMap

Organization Active NPI

Caldwell Memorial Hospital, Inc

Doing business as Chatham Rural Health Clinic

  • Rural Health Clinic/Center
  • Chatham, LA
National Provider Identifier
1114222072
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CALDWELL MEMORIAL HOSPITAL, INC
Doing business as
Chatham Rural Health Clinic
Practice address
6619 Highway 34
Chatham, LA 71226-9326
Phone
(318) 249-2743
Fax
(318) 649-5094
NPI assigned
Jan 24, 2011
Last updated
Mar 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CALDWELL MEMORIAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Authorized official

Name
Rhonda W Etheridge
Title
Office Manager
Phone
(318) 249-2743

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

6619 Highway 34
Chatham, LA 71226-9326

Mailing address

PO Box 899
Columbia, LA 71418-0899
Phone (318) 649-6111

Other names 1

  • Chatham Rural Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110408000710 LA Part A Provider - Rural Health Clinic 9638063944 Practice locations: Chatham, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114222072. Details of each certification follow.

Rural health clinic certification: CCN 193489

Legal name
CALDWELL MEMORIAL HOSPITAL, INC.
Doing business as
CHATHAM RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 14, 2012
Last certification
Feb 17, 2025
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Feb 14, 1980 in LA
Enrollment address
6619 Highway 34
Chatham, LA 71226-9326
Related CCNs
190190

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

Other NPIs with the same Medicare PAC ID 4

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

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
19D1103079Chatham Rural Health Clinic6619 Highway 134, Chatham, LA 71226Certificate of waiverAug 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Caldwell Memorial Hospital5 organizations share this tax ID, including this one
Part of
Caldwell Memorial Hospital

Other organizations with this tax ID 4

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

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/caldmem-57e7c173

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Michael Kramer Individual 5% Or Greater Direct Ownership InterestPresident Dec 12, 2025 50%
Corporate OfficerPresident Dec 12, 2025 50%
W-2 Managing EmployeePresident Dec 12, 2025 25%
Operational/Managerial ControlPresident Dec 12, 2025 25%
Lisa Patrick Individual Corporate OfficerChief Executive Officer Dec 14, 2012
W-2 Managing EmployeeChief Executive Officer Dec 14, 2012 50%
Operational/Managerial ControlChief Executive Officer Dec 14, 2012 50%
Jed Christopher Robinson Individual 5% Or Greater Direct Ownership InterestVice President Dec 12, 2025 50%
Corporate OfficerVice President Dec 12, 2025 50%
W-2 Managing EmployeeVice President Dec 12, 2025 25%
Operational/Managerial ControlVice President Dec 12, 2025 25%
Commercial Capital Bank Organization, Columbia, LA Financial institution 5% Or Greater Mortgage Interest Dec 12, 2025 79%

Owners & managing parties with NPI records 1

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

  • Jed Robinson, D.O.
    • Urology Physician
    • Winnsboro, LA
    • NPI 1164730917

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583452800000",
    "number": "1114222072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 899",
            "city": "COLUMBIA",
            "state": "LA",
            "postal_code": "714180899",
            "telephone_number": "318-649-6111",
            "fax_number": "318-649-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6619 HIGHWAY 34",
            "city": "CHATHAM",
            "state": "LA",
            "postal_code": "712269326",
            "telephone_number": "318-249-2743",
            "fax_number": "318-649-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALDWELL MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CALDWELL MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2011-01-24",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A",
        "authorized_official_last_name": "ETHERIDGE",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-249-2743"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chatham Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chatham Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chatham, LA

Sources for this page

Verify at the official NPI Registry.