NPIMap

Organization Active NPI

Capitol City Family Health Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Donaldsonville, LA
National Provider Identifier
1235486226
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Practice address
904 Catalpa Street
Donaldsonville, LA 70346
Phone
(225) 264-6800
Fax
(225) 264-6630
NPI assigned
Aug 8, 2012
Organization subpart
Yes
Parent organization
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Kenya L. Nelson
Title
Front Office/Billing Manager
Phone
(225) 650-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

904 Catalpa Street
Donaldsonville, LA 70346

Mailing address

PO Box 66156
Baton Rouge, LA 70896-6156
Phone (225) 650-2000

Other identifiers 1

IdentifierTypeStateIssuer
2317733MedicaidLA

Other names 1

  • CareSouth Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051130000101 LA Part B Supplier - Clinic/Group Practice 5193639151 Receives reassigned benefits from 94 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA; Zachary, LA; Shreveport, LA; Plaquemine, LA; Donaldsonville, LA
O20121210000245 LA Part A Provider - Federally Qualified Health Center (FQHC) 5193639151 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Donaldsonville, LA

Federally qualified health center certification: CCN 191899

Legal name
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Doing business as
CARESOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2013
Last certification
Jan 8, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1997 in LA
Enrollment address
904 Catalpa St
Donaldsonville, LA 70346-2946

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Capitol City Family HLT14 organizations share this tax ID, including this one
Part of
Capitol City Family HLT

Other organizations with this tax ID 13

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

View all 13

Locations

5000 Odonavan Blvd
Ste 404
Walker, LA 70785
Phone (225) 369-8100

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Kenneth Wright Individual Corporate DirectorPresident Aug 26, 2013
Edwin Walker Individual Corporate DirectorBoard Member Jun 1, 2018
Ruth Franklin Individual Corporate DirectorSecretary Mar 28, 2016
Maimouna Keita Individual Corporate OfficerCeo May 17, 2004
Kenya Nelson Individual Corporate OfficerBilling Manager Jan 1, 2005
Richard Andrus Individual Corporate DirectorBoard Member Sep 22, 2014
Dianna Payton-Collins Individual Corporate DirectorBoard Member Dec 22, 2012
Debra Butler Individual Corporate DirectorTreasurer Jun 1, 2018
Natalie Cooley Individual Corporate DirectorBoard Member Jun 1, 2018
Shirley Lolis Individual Corporate DirectorVice President Mar 31, 2014
Linda Cannon Individual Corporate DirectorBoard Vice President Jul 26, 2010
Elaine Patin Individual Corporate DirectorBoard Member Jun 1, 2018
Matthew Valliere Individual Corporate OfficerChief Executive Officer (Ceo) Jan 19, 2016
W-2 Managing Employee Jan 19, 2016
Edmond Jordan Individual Corporate DirectorBoard Member Mar 31, 2014

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1235486226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66156",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708966156",
            "telephone_number": "225-650-2000",
            "fax_number": "225-650-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 CATALPA STREET",
            "city": "DONALDSONVILLE",
            "state": "LA",
            "postal_code": "70346",
            "telephone_number": "225-264-6800",
            "fax_number": "225-264-6630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED",
        "enumeration_date": "2012-08-08",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KENYA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "FRONT OFFICE/BILLING MANAGER",
        "authorized_official_telephone_number": "225-650-2000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2317733",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CareSouth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Donaldsonville, LA

Sources for this page

Verify at the official NPI Registry.