NPIMap

Organization Active NPI

Acadiana Practitioners LLC

  • Rural Health Clinic/Center
  • Opelousas, LA
National Provider Identifier
1255809166
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACADIANA PRACTITIONERS LLC
Practice address
1119 Prudhomme Cir Ste F
Opelousas, LA 70570-6516
Phone
(337) 942-5899
Fax
(337) 942-5978
NPI assigned
Nov 8, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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

Authorized official

Name
Dustin Joseph Miller, NP
Title
President
Phone
(337) 447-4027

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1119 Prudhomme Cir Ste F
Opelousas, LA 70570-6516

Mailing address

414 Saizan Avenue
Port Barre, LA 70577
Phone (337) 447-4027

Other names 1

  • Acadiana Practitioners Opelousas Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180223000799 LA Part B Supplier - Clinic/Group Practice 4587924188 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Opelousas, LA; Port Barre, LA; Sunset, LA
O20190808000251 LA Part A Provider - Rural Health Clinic 4587924188 Practice locations: Opelousas, LA

Rural health clinic certification: CCN 193945

Legal name
ACADIANA PRACTITIONERS LLC
Doing business as
ACADIANA PRACTITIONERS OPELOUSAS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 4, 2019
Last certification
Nov 4, 2022
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Sep 6, 2017 in LA
Enrollment address
1119 Prudhomme Cir
Ste F
Opelousas, LA 70570-6516

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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

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
19D2166374Acadiana Practitioners Opelousas1119 Prudhomme Circle, Suite F, Opelousas, LA 70570Certificate of waiverMay 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Acadiana Practitioners LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1119 Prudhomme Cir
#F
Opelousas, LA 70570

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Rhonda Gerace Bergeron Individual 5% Or Greater Direct Ownership InterestPresident Sep 6, 2017 50%
General Partnership InterestPresident Sep 6, 2017 50%
Corporate OfficerPresident Sep 6, 2017 50%
Operational/Managerial ControlPresident Sep 6, 2017 50%
Dustin Joseph Miller Individual 5% Or Greater Direct Ownership InterestPresident Sep 6, 2017 50%
General Partnership InterestPresident Sep 6, 2017 50%
Corporate OfficerPresident Sep 6, 2017 50%
Operational/Managerial ControlPresident Sep 6, 2017 50%

Owners & managing parties with NPI records 2

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

  • Rhonda Gerace Bergeron, APRN, FNP
    • Family Nurse Practitioner
    • Port Barre, LA
    • NPI 1336250182

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

    CMS ownership
  • Dustin Joseph Miller, NP-C
    • Family Nurse Practitioner
    • Port Barre, LA
    • NPI 1790235000

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583107200000",
    "number": "1255809166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 SAIZAN AVENUE",
            "city": "PORT BARRE",
            "state": "LA",
            "postal_code": "70577",
            "telephone_number": "337-447-4027",
            "fax_number": "337-585-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 PRUDHOMME CIR STE F",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705706516",
            "telephone_number": "337-942-5899",
            "fax_number": "337-942-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIANA PRACTITIONERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-08",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-447-4027",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acadiana Practitioners Opelousas",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Acadiana Practitioners Opelousas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Opelousas, LA

Sources for this page

Verify at the official NPI Registry.