NPIMap

Organization Active NPI

Calcasieu Cameron Hospital Service District

Doing business as Vinton Medical Clinic

  • Rural Health Clinic/Center
  • Vinton, LA
National Provider Identifier
1316924400
Registry record updated Sep 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
097 Issued in LA
Legal business name
CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Doing business as
Vinton Medical Clinic
Practice address
1611 Hampton St
Vinton, LA 70668-3707
Phone
(337) 589-5951
Fax
(337) 589-4013
NPI assigned
Dec 29, 2005
Last updated
Sep 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2016

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

Authorized official

Name
Janie Fruge
Title
Ceo
Phone
(337) 527-4241

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 097 LA Primary

Addresses

Primary practice location

1611 Hampton St
Vinton, LA 70668-3707

Mailing address

1611 Hampton St
Vinton, LA 70668-3707
Phone (337) 589-5951

Other identifiers 1

IdentifierTypeStateIssuer
1942502MedicaidLA

Other names 1

  • Vinton Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040318000265 LA Part A Provider - Rural Health Clinic 1052221447 Practice locations: Vinton, LA
O20081104000079 LA Part B Supplier - Clinic/Group Practice 1052221447 Receives reassigned benefits from 60 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sulphur, LA; Vinton, LA; Hackberry, LA; Cameron, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316924400. Details of each certification follow.

Rural health clinic certification: CCN 193458

Legal name
CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Doing business as
VINTON MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 29, 2005
Last certification
Jan 5, 2018
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
1611 Hampton St
Vinton, LA 70668-3707
Related CCNs
190013

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 11

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

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
19D0889245Vinton Medical Clinic1611 Hampton Street, Vinton, LA 70668Certificate of waiverFeb 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
West Calca Sieu Cameron15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

1020 Main St
Hackberry, LA 70645
Phone (337) 762-3762

703 Cypress St
Ste A
Sulphur, LA 70663
Phone (337) 310-0395

Interoperability endpoints

  • Direct secure messaging: alisoncoleman@wcchs.allscriptsdirect.net
  • Direct secure messaging: andrewdavies@wcchs.allscriptsdirect.net
  • Direct secure messaging: angelajones@wcchs.allscriptsdirect.net
  • Direct secure messaging: ginamiller@wcchs.allscriptsdirect.net
  • Direct secure messaging: juliegalley@wcchs.allscriptsdirect.net
  • Direct secure messaging: karagoodin@wcchs.allscriptsdirect.net
  • Direct secure messaging: kevinschlamp@wcchs.allscriptsdirect.net
  • Direct secure messaging: lancewaldmeier@wcchs.allscriptsdirect.net
  • Direct secure messaging: ravalitarigopula@wcchs.allscriptsdirect.net
  • Direct secure messaging: rebeccapharris@wcchs.allscriptsdirect.net
  • Direct secure messaging: wendywingate@wcchs.allscriptsdirect.net
  • Direct secure messaging: yvonnealexander@wcchs.allscriptsdirect.net

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Joseph a Devall Individual Corporate DirectorBoard Member Feb 21, 2006 20%
Robert Letard Individual Corporate DirectorBoard Member Feb 22, 2005 20%
Janie Fruge Individual Corporate OfficerCeo Jul 1, 2013 100%
W-2 Managing EmployeeCeo Jul 1, 2013 100%
Operational/Managerial ControlCeo Jul 1, 2013 100%
Jobie James Individual Corporate OfficerCfo May 5, 2014 100%
W-2 Managing EmployeeCfo May 5, 2014 100%
Operational/Managerial ControlCfo May 5, 2014 100%
Rickey Watson Individual Corporate DirectorBoard Member Oct 10, 2013 20%
Robert Davidson Individual Corporate DirectorBoard Member Jan 25, 2000 20%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
West Calcasieu Cameron HospitalSulphur, LA, CCN 190013 Hospital Operational/Managerial Control (100%) Mar 1, 2013
Johnson Bayou Rural Health ClinicJohnson Bayou, LA, CCN 193479 Rural health clinic Operational/Managerial Control (100%) Nov 16, 2007

Owned or controlled facilities with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1316924400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 HAMPTON ST",
            "city": "VINTON",
            "state": "LA",
            "postal_code": "706683707",
            "telephone_number": "337-589-5951",
            "fax_number": "337-589-4013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 HAMPTON ST",
            "city": "VINTON",
            "state": "LA",
            "postal_code": "706683707",
            "telephone_number": "337-589-5951",
            "fax_number": "337-589-4013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "FRUGE",
        "authorized_official_first_name": "JANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-527-4241"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942502",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vinton Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vinton, LA

Sources for this page

Verify at the official NPI Registry.