NPIMap

Organization Active NPI

Primary Care Providers for a Healthy Feliciana, Inc.

Doing business as WBR Primary Care at Port Allen High School

  • Federally Qualified Health Center (FQHC)
  • Port Allen, LA
National Provider Identifier
1245969328
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.
Doing business as
WBR Primary Care at Port Allen High School
Practice address
3553 Rosedale Rd
Port Allen, LA 70767-4347
Phone
(225) 234-0227
Fax
(225) 683-1317
NPI assigned
Jun 6, 2022
Last updated
Jun 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Authorized official

Name
Chrisit C Hunt
Title
Ceo
Phone
(225) 683-5292

Specialties & licenses 1

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

Addresses

Primary practice location

3553 Rosedale Rd
Port Allen, LA 70767-4347

Mailing address

PO Box 395
Clinton, LA 70722-0395
Phone (225) 683-5292

Other names 1

  • WBR Primary Care at Port Allen High School Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040224000173 LA Part B Supplier - Clinic/Group Practice 1052220985 Receives reassigned benefits from 99 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, LA; Slaughter, LA; Port Allen, LA; Jackson, LA; Loranger, LA; Clinton, LA; Baton Rouge, LA; Livingston, LA
O20220707000971 LA Part A Provider - Federally Qualified Health Center (FQHC) 1052220985 Practice locations: Port Allen, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245969328. Details of each certification follow.

Federally qualified health center certification: CCN 191101

Legal name
PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
Doing business as
WBR PRIMARY CARE AT PORT ALLEN HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 5, 2022
Last certification
Jun 5, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 25, 2022 in LA
Enrollment address
3553 Rosedale Rd
Port Allen, LA 70767-4347

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
RKM Primary72 organizations share this tax ID, including this one
Part of
RKM Primary

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Richard C Holton Individual Corporate DirectorBoard Member Oct 25, 2007
Neil M Manuel Individual Corporate OfficerCoo Mar 28, 2022 10%
W-2 Managing EmployeeCoo May 25, 2022 10%
Operational/Managerial ControlCoo Mar 28, 2022 10%
Alfreda D Jackson Individual Corporate DirectorBoard Member Sep 29, 2009
Darie S Gilliam Individual Corporate OfficerCco Sep 15, 2018 10%
W-2 Managing EmployeeCco May 25, 2022 10%
Operational/Managerial ControlCco Sep 15, 2018 10%
Veronica D Easterly Individual Corporate DirectorBoard Member Sep 30, 2010
Kenny Sanders Individual Corporate DirectorBoard Member Sep 22, 2011
Bonnie Phillips Individual Corporate OfficerCfo Mar 29, 2018 10%
W-2 Managing EmployeeCfo May 25, 2022 10%
Operational/Managerial ControlCfo Mar 29, 2018 10%
Christi C Hunt Individual Corporate OfficerCeo Oct 17, 2020 70%
W-2 Managing EmployeeCeo May 25, 2022 70%
Virdie Moeller Individual Corporate DirectorBoard Member Mar 28, 2013
Nicole C Wilcher Individual Corporate DirectorBoard Member Mar 28, 2013
Wayne Birt Individual Corporate DirectorBoard Member Aug 31, 2020
Louis J Kent Individual Corporate DirectorBoard Member Aug 6, 1998
Columbus Hutchinson Individual Corporate DirectorBoard Member Mar 29, 2018
Anita P Cambre Individual Corporate DirectorBoard Member Oct 25, 2007
Mark Kemp Individual Corporate DirectorBoard Member Mar 28, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

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": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654473600000",
    "number": "1245969328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 395",
            "city": "CLINTON",
            "state": "LA",
            "postal_code": "707220395",
            "telephone_number": "225-683-5292",
            "fax_number": "225-683-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3553 ROSEDALE RD",
            "city": "PORT ALLEN",
            "state": "LA",
            "postal_code": "707674347",
            "telephone_number": "225-234-0227",
            "fax_number": "225-683-1317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-06",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "CHRISIT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-683-5292"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WBR Primary Care at Port Allen High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Allen, LA

Sources for this page

Verify at the official NPI Registry.