NPIMap

Organization Active NPI

Southside Family Clinic LLC

Doing business as Arnaudville Family Clinic

  • Rural Health Clinic/Center
  • Arnaudville, LA
National Provider Identifier
1164112074
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHSIDE FAMILY CLINIC LLC
Doing business as
Arnaudville Family Clinic
Practice address
119 Fuselier Rd
Arnaudville, LA 70512-6134
Phone
(337) 385-1972
NPI assigned
May 12, 2023
Last updated
May 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Authorized official

Name
John DiesNPI 1477971083
Title
President
Phone
(337) 580-4061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

119 Fuselier Rd
Arnaudville, LA 70512-6134

Mailing address

304 N Hospital Dr Ste a
Abbeville, LA 70510-4041
Phone (337) 385-1972

Other names 1

  • Arnaudville Family 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
O20171107000495 LA Part B Supplier - Clinic/Group Practice 3779859392 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Abbeville, LA; Delcambre, LA; Arnaudville, LA
O20231024001894 LA Part A Provider - Rural Health Clinic 3779859392 Practice locations: Arnaudville, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164112074. Details of each certification follow.

Rural health clinic certification: CCN 198930

Legal name
SOUTHSIDE FAMILY CLINIC LLC
Doing business as
ARNAUDVILLE FAMILY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 5, 2025
Last certification
Feb 5, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
May 25, 2017 in LA
Enrollment address
119 Fuselier Street
Arnaudville, LA 70512-6134

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

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
19D2299631Arnaudville Family Clinic119 Fuselier St, Arnaudville, LA 70512Certificate of waiverFeb 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Arnaudville Family Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

506 W Highway 14
Delcambre, LA 70528
Phone (337) 385-1972

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Joseph Heinen Individual 5% Or Greater Direct Ownership InterestPresident May 25, 2017 50%
General Partnership InterestPresident May 25, 2017 50%
Corporate OfficerPresident May 25, 2017 50%
Operational/Managerial ControlPresident May 25, 2017 50%
John P Dies Individual 5% Or Greater Direct Ownership InterestPresident May 25, 2017 50%
General Partnership InterestPresident May 25, 2017 50%
Corporate OfficerPresident May 25, 2017 50%
Operational/Managerial ControlPresident May 25, 2017 50%

Owners & managing parties with NPI records 2

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

  • John Dies, N.P.
    • Family Nurse Practitioner
    • Abbeville, LA
    • NPI 1477971083

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

    CMS ownership
  • Joseph Nicholas Heinen Sr., M.D.
    • Family Medicine Physician
    • Eunice, LA
    • NPI 1316188386

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1164112074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 N HOSPITAL DR STE A",
            "city": "ABBEVILLE",
            "state": "LA",
            "postal_code": "705104041",
            "telephone_number": "337-385-1972",
            "fax_number": "337-385-2849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 FUSELIER RD",
            "city": "ARNAUDVILLE",
            "state": "LA",
            "postal_code": "705126134",
            "telephone_number": "337-385-1972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "DIES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-580-4061"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arnaudville Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arnaudville, LA

Sources for this page

Verify at the official NPI Registry.