St. James Primary Care (Apmc)

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

110 Issued in LA

Legal business name

ST. JAMES PRIMARY CARE (APMC)

Practice address

827 Pine St
Gramercy, LA 70052-3659

Phone

(225) 869-9200

Fax

(225) 869-9241

NPI assigned

Jun 21, 2005

Last updated

Jun 14, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Anu Prasad Vellanki, M.D.NPI 1497746499

Title

M.D.

Phone

(225) 869-9200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164428629. Details of each certification follow.

• CCN 193870 Rural health clinic · Active · Details

Rural health clinic certification: CCN 193870

Legal name

ST JAMES PRIMARY CARE (APMC)

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 22, 2006

Last certification

Mar 1, 2018

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Mar 17, 2000 in LA

Enrollment address

827 N Pine St
Gramercy, LA 70052-3659

Other NPIs with the same Medicare PAC ID 2

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

• St. James Primary Care (Apmc)

  dba St. James Primary Care, Laplace

  • Rural Health Clinic/Center
  • La Place, LA
  • NPI 1457403503

  0941270961

  Same PAC ID
• St. James Primary Care, Apmc

  • General Practice Physician
  • Gramercy, LA
  • NPI 1346429453

  0941270961

  Same PAC ID

Tax ID family

St James Primary Care2 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.

• St. James Primary Care (Apmc)

  dba St. James Primary Care, Laplace

  • Rural Health Clinic/Center
  • La Place, LA
  • NPI 1457403503
  NPD tax ID

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.

Owners & managing parties with NPI records 2

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

• Anu Prasad Vellanki, MD

  • Internal Medicine Physician
  • Gramercy, LA
  • NPI 1497746499

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership
• Aparna Vellanki, MD

  • Internal Medicine Physician
  • La Place, LA
  • NPI 1215928213

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 1

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.

• Anu Prasad Vellanki, MD

  • Internal Medicine Physician
  • Gramercy, LA
  • NPI 1497746499
  Authorized official Same address or phone

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339632000000",
    "number": "1164428629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419",
            "city": "GRAMERCY",
            "state": "LA",
            "postal_code": "700520419",
            "telephone_number": "225-869-9200",
            "fax_number": "225-869-9241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 PINE ST",
            "city": "GRAMERCY",
            "state": "LA",
            "postal_code": "700523659",
            "telephone_number": "225-869-9200",
            "fax_number": "225-869-9241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JAMES PRIMARY CARE (APMC)",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2012-06-14",
        "status": "A",
        "authorized_official_last_name": "VELLANKI",
        "authorized_official_first_name": "ANU",
        "authorized_official_middle_name": "PRASAD",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "225-869-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvonne K Scott
• Daniel R Seward, NP
• Shirley Houston Smith
• St James Community Fresh Start Program
• St James Dialysis Center Inc
• St. James Primary Care, Apmc
• Teche Action Board, Inc. (Teche Health @ Gramercy)
• Minh Tran
• Roxann L. Tuircuit
• Anu Prasad Vellanki, MD

• Rural Health Clinic/Center in Gramercy, LA
• Providers in Gramercy, 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 Jun 14, 2012; 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.