NPIMap

Organization Active NPI

Council for Advancement of Social Service and Education

Doing business as CASSE - Shreveport Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
National Provider Identifier
1306455456
Registry record updated Jul 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Doing business as
CASSE - Shreveport Pediatrics
Practice address
2120 Bert Kouns Industrial Loop Ste K-L
Shreveport, LA 71118-3351
Phone
(318) 688-3350
NPI assigned
Jul 24, 2020
Last updated
Jul 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2020

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

Authorized official

Name
Mrs. Mary M Chumley, RN
Title
Ceo
Phone
(318) 688-3350

Specialties & licenses 1

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

Addresses

Primary practice location

2120 Bert Kouns Industrial Loop Ste K-L
Shreveport, LA 71118-3351

Mailing address

2120 Bert Kouns Industrial Loop Ste H
Shreveport, LA 71118-3354
Phone (318) 688-3350

Other names 1

  • CASSE - Shreveport Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210427001117 LA Part A Provider - Federally Qualified Health Center (FQHC) 8022043710 Practice locations: Shreveport, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306455456. Details of each certification follow.

Federally qualified health center certification: CCN 191077

Legal name
COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Organization structure
Not SelectedProprietary
Enrollment address
2120 Bert Kouns Industrial Loop
Ste K-L
Shreveport, LA 71118-3351

Other NPIs with the same Medicare PAC ID 5

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

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
19D2281032Casse Shreveport Pediatrics2120 Bert Kouns Industrial Loop, Suites K & L, Shreveport, LA 71118Certificate of waiverApr 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Council for the Advancement of Social Servies and Education10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Mary M Chumley Individual W-2 Managing Employee Sep 1, 2020

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Casse Community Health InstituteMansfield, LA, CCN 191883 Federally qualified health center Operational/Managerial Control Feb 13, 2006

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1306455456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 BERT KOUNS INDUSTRIAL LOOP STE H",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183354",
            "telephone_number": "318-688-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 BERT KOUNS INDUSTRIAL LOOP STE K-L",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183351",
            "telephone_number": "318-688-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "CHUMLEY",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-688-3350",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CASSE - Shreveport Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.