NPIMap

Organization Active NPI

David Raines Community Health Center, Inc

Doing business as David Raines Community Health Center- Mobile Medical Unit #1

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
National Provider Identifier
1275317455
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DAVID RAINES COMMUNITY HEALTH CENTER, INC
Doing business as
David Raines Community Health Center- Mobile Medical Unit #1
Practice address
1625 David Raines Rd
Shreveport, LA 71107-5899
Phone
(318) 425-2252
NPI assigned
Aug 21, 2023
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
DAVID RAINES COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Mr. Willie C. White III
Title
Chief Executive Officer
Phone
(318) 227-3342

Specialties & licenses 1

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

Addresses

Primary practice location

1625 David Raines Rd
Shreveport, LA 71107-5899

Mailing address

3041 Dr Martin Luther King Dr
Shreveport, LA 71107-4705
Phone (318) 227-3350

Other names 1

  • David Raines Community Health Center- Mobile Medical Unit #1 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041007000508 LA Part B Supplier - Clinic/Group Practice 4688586118 Receives reassigned benefits from 67 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gilliam, LA; Shreveport, LA; Minden, LA; Keithville, LA; Hayneville, LA; Bossier City, LA

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
David Raines Community Health Center26 organizations share this tax ID, including this one
Part of
David Raines Community Health Center

Other organizations with this tax ID 25

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

View all 25

Practitioners & affiliated clinicians

Practitioners 3

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": "1692576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1275317455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 DR MARTIN LUTHER KING DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711074705",
            "telephone_number": "318-227-3350",
            "fax_number": "318-222-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 DAVID RAINES RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711075899",
            "telephone_number": "318-425-2252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID RAINES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVID RAINES COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "318-227-3342",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David Raines Community Health Center- Mobile Medical Unit #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.