NPIMap

Organization Active NPI

Ochsner Lsu Health Shreveport - St. Mary Medical Center, LLC

  • Women's Hospital
  • Shreveport, LA
National Provider Identifier
1285253252
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's HospitalTaxonomy code 282NW0100X
Legal business name
OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER, LLC
Practice address
911 Margaret PL
Shreveport, LA 71101-4347
Phone
(318) 626-4300
Fax
(318) 399-7683
NPI assigned
Apr 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

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

Authorized official

Name
Mitzi Green
Title
Director
Phone
(318) 626-0050

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X
Children's Hospital 282NC2000X
Women's Hospital 282NW0100X Primary

Addresses

Primary practice location

911 Margaret PL
Shreveport, LA 71101-4347

Mailing address

1512 W Kirby PL
Shreveport, LA 71103-3822
Phone (318) 626-0287

Other names 1

  • Ochsner LSU Health Shreveport - St. Mary Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200423001278 LA Part A Provider - Hospital 7810327343 Practice locations: Shreveport, LA; Bossier City, LA
O20200917001890 LA Part B Supplier - Clinic/Group Practice 7810327343 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Shreveport, LA; Bossier City, LA

Hospital certification: CCN 190317

Legal name
OCHSNER LSU HEALTH SHREVEPORT - ST MARY MEDICAL CENTER LLC
Doing business as
OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Apr 28, 2020
Last certification
Feb 24, 2024
Beds
93
Ownership / control type
Private (not for profit)
Organization structure
LLCNon-profit
Enrollment address
911 Margaret PL
Shreveport, LA 71101-4347
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ochsner Lsu Health Shreveport-St Mary Medical CentCCN 190317
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Locations

4481 Viking Dr
Bossier City, LA 71111
Phone (318) 626-2593

8445 Line Ave
Shreveport, LA 71106
Phone (318) 703-5655

255 Bert Kouns Loop
Shreveport, LA 71106

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Olh Operational Management Company LLC Organization, Shreveport, LA LLC Operational/Managerial Control Apr 25, 2020
David L Callecod Individual Contracted Managing EmployeeCeo-Ochsner Lsu Health Feb 11, 2025
Corporate OfficerCeo-Ochsner Lsu Health Feb 11, 2025
Ochsner Clinic Foundation Organization, New Orleans, LA Corporation, Non-profit, Chain home office Operational/Managerial Control Apr 25, 2020
Other Apr 25, 2020
Riley W. Waddell Individual Contracted Managing EmployeeChief Executive Officer Feb 21, 2022
Corporate OfficerChief Executive Officer Feb 21, 2022
Operational/Managerial ControlChief Executive Officer Feb 21, 2022
BRF Hospital Holdings LLC Organization, Shreveport, LA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 25, 2020 100%
Operational/Managerial Control Apr 25, 2020
Ochsner Lsu Health System of North Louisiana Organization, Shreveport, LA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Apr 25, 2020 100%
Charles J Fox Individual Contracted Managing EmployeeChief Medical Officer Apr 25, 2020
Corporate OfficerChief Medical Officer Apr 25, 2020
David Ford Lewis Individual Contracted Managing EmployeeOlhs-NL Chief Medical Officer Apr 25, 2020

Owners & managing parties with NPI records 4

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

Facilities with the same owner 78

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 78

Practitioners & affiliated clinicians

Practitioners 46

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

View all 46

Affiliated clinicians 312

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 312

NPI Registry JSON

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

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1285253252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 W KIRBY PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033822",
            "telephone_number": "318-626-0287",
            "fax_number": "318-629-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 MARGARET PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014347",
            "telephone_number": "318-626-4300",
            "fax_number": "318-399-7683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCHSNER LSU HEALTH SHREVEPORT - ST. MARY MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-10",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "MITZI",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "318-626-0050"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NW0100X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Women",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ochsner LSU Health Shreveport - St. Mary Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.