NPIMap

Organization Active NPI

Christus Health Southwestern Louisiana

Doing business as Molo Middle SBHC

  • Student Health Clinic/Center
  • Lake Charles, LA
National Provider Identifier
1205040995
Registry record updated Jul 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
CHRISTUS HEALTH SOUTHWESTERN LOUISIANA
Doing business as
Molo Middle SBHC
Practice address
2300 Medora St
Lake Charles, LA 70601-1204
Phone
(337) 437-3977
Fax
(337) 437-8203
NPI assigned
May 10, 2007
Last updated
Jul 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2022

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

Authorized official

Name
Paul Trevino
Title
Ceo
Phone
(409) 899-8191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X NU Primary

Addresses

Primary practice location

2300 Medora St
Lake Charles, LA 70601-1204

Mailing address

524 Dr Michael Debakey Dr
Lake Charles, LA 70601-5725
Phone (337) 437-3977

Other identifiers 1

IdentifierTypeStateIssuer
1447161MedicaidLA

Other names 1

  • Molo Middle SBHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040702000393 LA Part A Provider - Hospital 5799695839 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake Charles, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205040995. Details of each certification follow.

Hospital certification: CCN 190027

Legal name
CHRISTUS HEALTH SOUTHWESTERN LOUISIANA
Doing business as
CHRISTUS OCHSNER ST PATRICK HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 27, 2025
Beds
230
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 11, 1921 in LA
Enrollment address
524 Dr Michael Debakey Dr
Lake Charles, LA 70601-5725
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Christus Ochsner St Patrick HospitalCCN 190027 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Matthew Block Individual Corporate DirectorBoard Member Jan 1, 2024
Christus Health Organization, Irving, TX Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Feb 1, 1999 60%
James F Davidson Individual Corporate OfficerPresident & Coo Feb 1, 2021
W-2 Managing EmployeePresident & Coo Feb 1, 2021
Charles D Daigle Individual Corporate DirectorBoard Member Jan 1, 2023
Ochsner Clinic Foundation Organization, New Orleans, LA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2018 40%
Dennis Stine Individual Corporate Director Sep 1, 2018
Sonia Acosta Individual Corporate DirectorCorporate Secretary Sep 16, 2024
Monte Wilson Individual Corporate OfficerCeo Oct 1, 2025
Corporate Director Oct 1, 2025
Nikki Martin Individual Corporate OfficerCfo Jun 22, 2021
Fadi V Nasrallah Individual Corporate DirectorBoard Member Feb 22, 2024

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 330

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 330

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656979200000",
    "number": "1205040995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015725",
            "telephone_number": "337-437-3977",
            "fax_number": "337-437-8203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 MEDORA ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706011204",
            "telephone_number": "337-437-3977",
            "fax_number": "337-437-8203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS HEALTH SOUTHWESTERN LOUISIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A",
        "authorized_official_last_name": "TREVINO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "409-899-8191"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447161",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Molo Middle SBHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Molo Middle SBHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.