CCP Primary Care Center

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP04512 Issued in LA

Legal business name

CCP PRIMARY CARE CENTER

Practice address

1101 Eraste Landry Rd
Lafayette, LA 70506-3043

Phone

(337) 289-6690

NPI assigned

Feb 24, 2006

Organization subpart

No

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

Authorized official

Name

Grover Phipps

Title

Managing Partner

Phone

(337) 289-6690

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Scott Christopher Chapman, MD

  • General Practice Physician
  • Lafayette, LA
  • NPI 1447226741

  Pain Medicine

  NPD (past)
• Tosheiba Mistique Holmes, MD

  • Family Medicine Physician
  • Lafayette, LA
  • NPI 1154334845
  NPD (past)

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1336115997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 ERASTE LANDRY RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705063043",
            "telephone_number": "337-289-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 ERASTE LANDRY RD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705063043",
            "telephone_number": "337-289-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCP PRIMARY CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "PHIPPS",
        "authorized_official_first_name": "GROVER",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "337-289-6690"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "LA",
            "license": "022833",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "AP04512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14-47692",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael R. Cavanaugh, D.C.
• Shavondali Harris Cawthorne, FNP-C
• CCFR, LLC
• CCP Medical Management LLC
• CCP Medical Management, LLC
• CD Medical Transit LLC
• CD&J Management, LLC
• CD&J Management, LLC
• CD&J Management, LLC
• Cheryl Ceasar

• Nurse Practitioner in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.