NPIMap

Organization Active NPI

Iberia Comprehensive Community Health Center, Inc.

Doing business as Vernon Parish Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Leesville, LA
National Provider Identifier
1235634486
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.
Doing business as
Vernon Parish Community Health Center
Practice address
298 Nolan Trace Pkwy.
Leesville, LA 71446
Phone
(337) 365-4945
NPI assigned
Mar 29, 2018
Last updated
Dec 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Authorized official

Name
Roderick Charles Campbell
Title
Ceo
Phone
(337) 365-4945

Specialties & licenses 1

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

Addresses

Primary practice location

298 Nolan Trace Pkwy.
Leesville, LA 71446

Mailing address

806 Jefferson Ter
New Iberia, LA 70560-5727
Phone (337) 365-4945

Other identifiers 1

IdentifierTypeStateIssuer
00000OtherNO NUMBERS RECEIVED YET-NEW APPLICATION

Other names 1

  • Vernon Parish Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050809000029 LA Part B Supplier - Clinic/Group Practice 6204817828 Receives reassigned benefits from 43 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Leesville, LA; Saint Martinville, LA; New Iberia, LA; Merryville, LA; Many, LA; Lafayette, LA; Deridder, LA; Abbeville, LA
O20181227002284 LA Part A Provider - Federally Qualified Health Center (FQHC) 6204817828 Practice locations: Leesville, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235634486. Details of each certification follow.

Federally qualified health center certification: CCN 191009

Legal name
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER,INC.
Doing business as
VERNON PARISH COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 27, 2018
Last certification
Dec 27, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 4, 1994 in LA
Enrollment address
298 Nolan Trace Parkway
Leesville, LA 71446-3912

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
St Martin Parish CHC Pharmacy15 organizations share this tax ID, including this one
Part of
St Martin Parish CHC Pharmacy

Other organizations with this tax ID 14

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

View all 14

Locations

1009 Charity St
Abbeville, LA 70510
Phone (337) 893-3443

298 Nolan Trce
Leesville, LA 71446
Phone (337) 392-0110

1050 N Robinson St
Many, LA 71449
Phone (318) 256-8150

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Bradley Fulgence Individual Corporate OfficerBoard Vice-Chair Jan 1, 2018
Sandra Moore Individual Corporate OfficerBoard Chair Jan 1, 2000
Margaret Green Individual Corporate OfficerBoard Treasurer Jan 1, 2012
Roderick C Campbell Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 5%
Corporate OfficerCeo Feb 28, 2002
W-2 Managing Employee Feb 28, 2002

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1235634486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 JEFFERSON TER",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705605727",
            "telephone_number": "337-365-4945",
            "fax_number": "337-376-6860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 NOLAN TRACE PKWY.",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "71446",
            "telephone_number": "337-365-4945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.",
        "enumeration_date": "2018-03-29",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-365-4945"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NO NUMBERS RECEIVED YET-NEW APPLICATION",
            "identifier": "00000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vernon Parish Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vernon Parish Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesville, LA

Sources for this page

Verify at the official NPI Registry.