NPIMap

Organization Active NPI

Capitol City Family Health Center Incorporated

Doing business as CareSouth

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
National Provider Identifier
1265548614
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Doing business as
CareSouth
Practice address
3140 Florida Street
Baton Rouge, LA 70806
Phone
(225) 650-2000
Fax
(225) 650-2099
NPI assigned
Aug 21, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Ms. Kenya L Nelson
Title
Billing/Credentialing Manager
Phone
(225) 650-2000

Specialties & licenses 1

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

Addresses

Primary practice location

3140 Florida Street
Baton Rouge, LA 70806

Mailing address

PO Box 66156
Baton Rouge, LA 70896-6156
Phone (225) 650-2000

Other identifiers 1

IdentifierTypeStateIssuer
1948055MedicaidLA

Other names 1

  • CareSouth Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031114000360 LA Part A Provider - Federally Qualified Health Center (FQHC) 5193639151 Practice locations: Baton Rouge, LA
O20051130000101 LA Part B Supplier - Clinic/Group Practice 5193639151 Receives reassigned benefits from 94 practitioners
8 other NPIs on this enrollment
Practice locations: Baton Rouge, LA; Zachary, LA; Shreveport, LA; Plaquemine, LA; Donaldsonville, LA
O20121210000245 LA Part A Provider - Federally Qualified Health Center (FQHC) 5193639151 1 other NPI on this enrollment
Practice locations: Donaldsonville, LA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1265548614. Details of each certification follow.

Federally qualified health center certification: CCN 191827

Legal name
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Doing business as
CARESOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1998
Last certification
Jun 1, 1998
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1997 in LA
Enrollment address
3140 Florida Street
Baton Rouge, LA 70606-3757

Federally qualified health center certification: CCN 191899

Legal name
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Doing business as
CARESOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2013
Last certification
Jan 8, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1997 in LA
Enrollment address
904 Catalpa St
Donaldsonville, LA 70346-2946

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

4852 Zachary Slaughter Hwy
Ste A
Zachary, LA 70791
Phone (225) 654-7000

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Kenneth Wright Individual Corporate DirectorPresident Aug 26, 2013
Edwin Walker Individual Corporate DirectorBoard Member Jun 1, 2018
Ruth Franklin Individual Corporate DirectorSecretary Mar 28, 2016
Maimouna Keita Individual Corporate OfficerCeo May 17, 2004
Kenya Nelson Individual Corporate OfficerBilling Manager Jan 1, 2005
Richard Andrus Individual Corporate DirectorBoard Member Sep 22, 2014
Dianna Payton-Collins Individual Corporate DirectorBoard Member Dec 22, 2012
Debra Butler Individual Corporate DirectorTreasurer Jun 1, 2018
Natalie Cooley Individual Corporate DirectorBoard Member Jun 1, 2018
Shirley Lolis Individual Corporate DirectorVice President Mar 31, 2014
Linda Cannon Individual Corporate DirectorBoard Vice President Jul 26, 2010
Elaine Patin Individual Corporate DirectorBoard Member Jun 1, 2018
Matthew Valliere Individual Corporate OfficerChief Executive Officer (Ceo) Jan 19, 2016
W-2 Managing Employee Jan 19, 2016
Edmond Jordan Individual Corporate DirectorBoard Member Mar 31, 2014

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Care SouthPlaquemine, LA, CCN 191943 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 10, 2014
CaresouthZachary, LA, CCN 191981 Federally qualified health center Other Dec 6, 1997

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 100

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.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1265548614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66156",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708966156",
            "telephone_number": "225-650-2000",
            "fax_number": "225-650-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3140 FLORIDA STREET",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70806",
            "telephone_number": "225-650-2000",
            "fax_number": "225-650-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KENYA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "225-650-2000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1948055",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CareSouth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.