NPIMap

Organization Active NPI

CLHG-Ruston LLC

Doing business as Ruston Physician Practices

  • General Practice Physician
  • Ruston, LA
National Provider Identifier
1245964931
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CLHG-RUSTON LLC
Doing business as
Ruston Physician Practices
Practice address
401 E Vaughn Ave
Ruston, LA 71270-5950
Phone
(318) 254-2100
NPI assigned
Jul 11, 2022
Last updated
Sep 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Authorized official

Name
Rock Matthew Bordelon
Title
Owner
Phone
(318) 629-3269

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X NU
General Practice Physician 208D00000X NU Primary
Clinic/Center 261Q00000X NU
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

401 E Vaughn Ave
Ruston, LA 71270-5950

Mailing address

401 E Vaughn Ave
Ruston, LA 71270-5950
Phone (318) 254-2453

Other names 1

  • Ruston Physician Practices Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220718002173 LA Part B Supplier - Clinic/Group Practice 7315361425 Receives reassigned benefits from 41 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ruston, LA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Ruston LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

411 E Vaughn Ave
Ste 104
Ruston, LA 71270
Phone (318) 254-2453

Practitioners & affiliated clinicians

Practitioners 8

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": "1657497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1245964931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E VAUGHN AVE",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705950",
            "telephone_number": "318-254-2453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E VAUGHN AVE",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705950",
            "telephone_number": "318-254-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-RUSTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "BORDELON",
        "authorized_official_first_name": "ROCK",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-629-3269"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ruston Physician Practices",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.