Southeast Community Health Systems
Organization Active NPI Federally Qualified Health Center (FQHC) · Zachary, LA
NPI 1225748635 · NPPES record last updated Apr 25, 2023
Key facts
- NPI
- 1225748635
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHEAST COMMUNITY HEALTH SYSTEMS
- Practice address
- 4200 Pope Road
Ste 504
Zachary, LA 70791 - Phone
- (225) 306-2000
- Fax
- (225) 658-9443
- NPI assigned
- Nov 28, 2022
- Organization subpart
- No
Authorized official
- Name
- Virginia Foster
- Title
- Credentialing Specialist
- Phone
- (225) 306-2067
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 22
Corporate family (same tax ID) 36
Practitioners 22
-
Rainier Batiste, D.O.
-
Anna Jones Ardoin, FNP-C
-
Derrien Darshay Baker, FNP-C
-
Fiona Dillon, PMHNP
-
Caleshia Gaines, PMHNP-BC
-
Corey M Hall, M.D.
-
Deshanda Nicole May, CRNP
-
Heather Muse, FNP
-
Debralee Ann Populis, APRN-BC, MSN, FNP
-
Denise Ann Thomas, NURSE PRACTITIONER
-
Marvin Marcus Trotter, D.P.M.
-
Kizzy Woods, NP
-
Lucy Rena' Mikell, MSN, APRN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Federally qualified health center certification: CCN 711088
- Legal name
- SOUTHEAST COMMUNITY HEALTH SYSTEMS
- Doing business as
- SOUTHEAST COMMUNITY HEALTH SYSTEMS - NORTHWESTERN ELEMENTARY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 13, 2025
- Last certification
- Feb 13, 2025
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 4200 Pope Rd
Ste 504
Zachary, LA 70791
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Terry Addison |
Corporate Officer |
Nov 1, 2022 | |
| Mira L Robertson |
Corporate Officer |
Nov 1, 2022 | |
| Rochell Bates |
Corporate Officer |
Nov 1, 2022 | |
| Major Coleman |
Corporate Officer |
Nov 1, 2022 | |
| Margaret Smith |
Corporate Officer |
Nov 1, 2022 | |
| Michael Martin |
Corporate Officer |
Nov 1, 2022 | |
| Alecia Cyprian |
W-2 Managing Employee |
Nov 1, 2022 | |
| Virginia Reeves Foster |
W-2 Managing Employee |
Nov 1, 2022 | |
| Paula McNabb |
Corporate Officer |
Nov 1, 2022 | |
| Reyna E Lopez |
Corporate Officer |
Nov 1, 2022 | |
| Sandy K Tillery |
Corporate Officer |
Nov 1, 2022 | |
| Dameon Jackson |
Corporate Officer |
Nov 1, 2022 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Kentwood |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2008 |
| Albany |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2013 |
| Independence |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2008 |
| WMG |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jan 1, 2008 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050124000119 | LA | Part B Supplier - Clinic/Group Practice | 4284610437 |
Receives reassigned benefits from 36 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Greensburg, LA; Zachary, LA; Independence, LA; Kentwood, LA |
| O20250226001082 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 4284610437 | Practice locations: Zachary, LA |
National Provider Directory
- Tax ID family
- SE Community Health Systems
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
4200 Pope Road
Ste 504
Zachary, LA 70791
Mailing address
PO Box 770
Zachary, LA 70791-0770
Phone (225) 306-2067
Other names
- Southeast Community Health Systems Northwestern Elementary
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vfoster@shchc.org | Direct |
Other providers in Zachary, LA
- Shaleshia Snowden
- Robert Paul Sonnier
- Southeast Community Health Systems
- Southeast Community Health Systems
- Southeast Community Health Systems
- Southeast Community Health Systems
- Southeast Community Health Systems
- Southeast Community Health Systems
- Southeast Community Health Systems
- Myiesha Spears-Beard
All providers in Zachary, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2023. 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.