St. James Primary Care (Apmc)
Organization Active NPI Rural Health Clinic/Center · Gramercy, LA
NPI 1164428629 · NPPES record last updated Jun 14, 2012
Key facts
- NPI
- 1164428629
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 110 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Anu Prasad Vellanki, M.D.
- Title
- M.D.
- Phone
- (225) 869-9200
Owners & managing parties with NPI records 2
-
Aparna Vellanki, MD
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 1
Practitioners 2
-
Katie Chiasson Hymel, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
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
- Corporation · Proprietary
- Incorporated
- Mar 17, 2000 in LA
- Enrollment address
- 827 N Pine St
Gramercy, LA 70052-3659
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Aparna Vellanki |
5% Or Greater Direct Ownership Interest | Oct 1, 1999 | |
| Anu P Vellanki |
5% Or Greater Direct Ownership Interest | Oct 1, 1999 | |
| Corporate Director | Mar 20, 2006 | ||
| W-2 Managing Employee | Oct 1, 1999 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060320000346 | LA | Part a Provider - Rural Health Clinic | 0941270961 | Practice locations: Gramercy, LA |
National Provider Directory
- Tax ID family
- St James Primary Care Apmc
Locations
2471 Louisiana Ave
Lutcher, LA 70071
Phone (225) 869-3344
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 110 | LA | Yes |
Addresses
Primary practice location
827 Pine St
Gramercy, LA 70052-3659
Mailing address
PO Box 419
Gramercy, LA 70052-0419
Phone (225) 869-9200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5CE42 | Other | LA | MEDICARE GROUP |
| 057843586A | Other | LA | BLUE CROSS BLUE SHIELD |
| 1448800 | Medicaid | LA |
Other providers in Gramercy, LA
- Yvonne K Scott
- Daniel R Seward
- Shirley Houston Smith
- St James Community Fresh Start Program
- St James Dialysis Center Inc
- St. James Primary Care, Apmc
- Teche Action Board, Inc.
- Minh Tran
- Roxann L. Tuircuit
- Anu Prasad Vellanki
All providers in Gramercy, LA · Rural Health Clinic/Center in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.