NPIMap

Organization Active NPI

Community Care Clinic LLC

  • Primary Care Clinic/Center
  • West Monroe, LA
National Provider Identifier
1265671754
Registry record updated Feb 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
RN97721APO5017 Issued in LA
Legal business name
COMMUNITY CARE CLINIC LLC
Practice address
5328 Cypress St
West Monroe, LA 71291-7506
Phone
(318) 397-3636
Fax
(318) 397-3639
NPI assigned
Feb 6, 2009
Last updated
Feb 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2009

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

Authorized official

Name
Mrs. Jessica Bamburg Sharp, FNPNPI 1629164280
Title
Family Nurse Practitioner- Co-Owner
Phone
(318) 397-3636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X RN97721APO5017 LA Primary
Primary Care Clinic/Center 261QP2300X RN073699APO3572 LA

Addresses

Primary practice location

5328 Cypress St
West Monroe, LA 71291-7506

Mailing address

PO Box 2069
West Monroe, LA 71294-2069
Phone (318) 397-3636

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090406000011 LA Part B Supplier - Clinic/Group Practice 5597812719 Receives reassigned benefits from 6 practitioners
Practice locations: West Monroe, LA

National Provider Directory

National Provider Directory

Locations

5328 Cypress St
West Monroe, LA 71291
Phone (318) 397-3636

Practitioners & affiliated clinicians

Practitioners 6

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": "1233878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233878400000",
    "number": "1265671754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2069",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712942069",
            "telephone_number": "318-397-3636",
            "fax_number": "318-397-3639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5328 CYPRESS ST",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712917506",
            "telephone_number": "318-397-3636",
            "fax_number": "318-397-3639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-06",
        "last_updated": "2009-02-06",
        "status": "A",
        "authorized_official_last_name": "SHARP",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "BAMBURG",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER- CO-OWNER",
        "authorized_official_telephone_number": "318-397-3636",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "LA",
            "license": "RN97721APO5017",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "LA",
            "license": "RN073699APO3572",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; 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.