NPIMap

Organization Active NPI

Morehouse General Hospital

Doing business as MGH Rural Health Clinic

  • Rural Health Clinic/Center
  • Bastrop, LA
National Provider Identifier
1245544923
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MOREHOUSE GENERAL HOSPITAL
Doing business as
MGH Rural Health Clinic
Practice address
420 Gunby Ave
Bastrop, LA 71220-4406
Phone
(318) 283-3920
Fax
(318) 239-8920
NPI assigned
Aug 5, 2010
Last updated
Jan 3, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MOREHOUSE GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Authorized official

Name
Elmore Patterson
Title
Chief Executive Officer
Phone
(318) 283-3602

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

420 Gunby Ave
Bastrop, LA 71220-4406

Mailing address

PO Box 293
Bastrop, LA 71221-0293
Phone (318) 283-3620

Other identifiers 1

IdentifierTypeStateIssuer
2302914MedicaidLA

Other names 1

  • MGH Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101105000653 LA Part A Provider - Rural Health Clinic 4284528274 Practice locations: Bastrop, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245544923. Details of each certification follow.

Rural health clinic certification: CCN 193487

Legal name
MOREHOUSE GENERAL HOSPITAL
Doing business as
MGH RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 17, 2011
Last certification
Apr 18, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
420 Gunby Ave
Bastrop, LA 71220-4406
Related CCNs
190116

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

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2026349Morehouse General Hospital Rural Health Clinic420 Gunby Ave, Bastrop, LA 71220Certificate of waiverJun 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Morehouse Parish Hospit5 organizations share this tax ID, including this one
Part of
Morehouse Parish Hospit

Other organizations with this tax ID 4

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Christina Phillips Individual W-2 Managing EmployeeChief Nursing Officer Apr 23, 2025
Richard Baland Individual Corporate OfficerChief Financial Officer Apr 23, 2025
W-2 Managing EmployeeChief Financial Officer Apr 23, 2025
Lindzay Wilmore Individual W-2 Managing EmployeeRevenue Cycle Director Apr 23, 2025

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Alliant Management ServicesBastrop, LA, CCN 19S116 Hospital Operational/Managerial Control (100%) Aug 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1245544923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 293",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712210293",
            "telephone_number": "318-283-3620",
            "fax_number": "318-239-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 GUNBY AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204406",
            "telephone_number": "318-283-3920",
            "fax_number": "318-239-8920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOREHOUSE GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOREHOUSE GENERAL HOSPITAL",
        "enumeration_date": "2010-08-05",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "ELMORE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "318-283-3602"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2302914",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MGH Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bastrop, LA

Sources for this page

Verify at the official NPI Registry.