Primary Care Providers for a Healthy Feliciana, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Port Allen, LA
NPI 1245969328 · NPPES record last updated Jun 6, 2022
Key facts
- NPI
- 1245969328
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.
- Practice address
- 3553 Rosedale Rd
Port Allen, LA 70767-4347 - Phone
- (225) 234-0227
- Fax
- (225) 683-1317
- NPI assigned
- Jun 6, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
Authorized official
- Name
- Chrisit C Hunt
- Title
- Ceo
- Phone
- (225) 683-5292
Owners & managing parties with NPI records 1
-
Darie S. Gilliam, FNP-C
Other NPIs on the same Medicare enrollment 11
Corporate family (same tax ID) 24
Practitioners 2
-
William Harlan Bell, APRN
-
Alison Niemi, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
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
- Corporation · Non-profit
- Incorporated
- May 25, 2022 in LA
- Enrollment address
- 3553 Rosedale Rd
Port Allen, LA 70767-4347
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Richard C Holton |
Corporate Director |
Oct 25, 2007 | |
| Neil M Manuel |
Corporate Officer |
Mar 28, 2022 | 10% |
| W-2 Managing Employee |
May 25, 2022 | 10% | |
| Operational/Managerial Control |
Mar 28, 2022 | 10% | |
| Alfreda D Jackson |
Corporate Director |
Sep 29, 2009 | |
| Darie S Gilliam |
Corporate Officer |
Sep 15, 2018 | 10% |
| W-2 Managing Employee |
May 25, 2022 | 10% | |
| Operational/Managerial Control |
Sep 15, 2018 | 10% | |
| Veronica D Easterly |
Corporate Director |
Sep 30, 2010 | |
| Kenny Sanders |
Corporate Director |
Sep 22, 2011 | |
| Bonnie Phillips |
Corporate Officer |
Mar 29, 2018 | 10% |
| W-2 Managing Employee |
May 25, 2022 | 10% | |
| Operational/Managerial Control |
Mar 29, 2018 | 10% | |
| Christi C Hunt |
Corporate Officer |
Oct 17, 2020 | 70% |
| W-2 Managing Employee |
May 25, 2022 | 70% | |
| Virdie Moeller |
Corporate Director |
Mar 28, 2013 | |
| Nicole C Wilcher |
Corporate Director |
Mar 28, 2013 | |
| Wayne Birt |
Corporate Director |
Aug 31, 2020 | |
| Louis J Kent |
Corporate Director |
Aug 6, 1998 | |
| Columbus Hutchinson |
Corporate Director |
Mar 29, 2018 | |
| Anita P Cambre |
Corporate Director |
Oct 25, 2007 | |
| Mark Kemp |
Corporate Director |
Mar 28, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Primary Care Providers for a Healthy Feliciana Inc
- Part of
- Primary Care Providers for a Healthy Feliciana Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | LA |
Other names
- WBR Primary Care at Port Allen High School
Other providers in Port Allen, LA
- Port City Enterprises, Inc.
- Port City Enterprises, Inc.
- Primary Care Providers for a Healthy Feliciana Inc
- Primary Care Providers for a Healthy Feliciana Inc
- Primary Care Providers for a Healthy Feliciana, Inc
- Kristi Crochet Rabalais
- Tanya Cannon Rachal
- Santhosh K Reddy
- Erika Richard
- Cedric R Richardson
All providers in Port Allen, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.