NPIMap

Organization Active NPI

Acadiana Practitioners LLC

  • Rural Health Clinic/Center
  • Port Barre, LA
National Provider Identifier
1346755154
Registry record updated Jun 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
2203783812 Issued in LA
Legal business name
ACADIANA PRACTITIONERS LLC
Practice address
414 Saizan Avenue
Port Barre, LA 70577
Phone
(337) 447-4027
Fax
(337) 585-2674
NPI assigned
Dec 4, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2018

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

Authorized official

Name
Dustin Joseph Miller, FNP-CNPI 1790235000
Title
President
Phone
(337) 447-4027

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X 2203783812 LA Primary

Addresses

Primary practice location

414 Saizan Avenue
Port Barre, LA 70577

Mailing address

2124 Highway 742
Opelousas, LA 70570-0542

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180221000713 LA Part A Provider - Rural Health Clinic 4587924188 Practice locations: Port Barre, LA
O20180223000799 LA Part B Supplier - Clinic/Group Practice 4587924188 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
Practice locations: Opelousas, LA; Port Barre, LA; Sunset, LA

Rural health clinic certification: CCN 193936

Legal name
ACADIANA PRACTITIONERS LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 14, 2018
Last certification
May 14, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Sep 6, 2017 in LA
Enrollment address
414 Saizan Avenue
Port Barre, LA 70577-5156

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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
19D2142096Acadiana Practitioners, LLC414 Saizan Ave, Port Barre, LA 70577Certificate of waiverJan 2, 2028

National Provider Directory

National Provider Directory

Locations

331 S Main St
Opelousas, LA 70570
Phone (337) 942-7155

1119 Prudhomme Cir
Opelousas, LA 70570
Phone (337) 447-4027

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Rhonda Gerace Bergeron Individual 5% Or Greater Direct Ownership InterestPresident Sep 6, 2017 50%
General Partnership InterestPresident Sep 6, 2017 50%
Corporate OfficerPresident Sep 6, 2017 50%
Operational/Managerial ControlPresident Sep 6, 2017 50%
Dustin Joseph Miller Individual 5% Or Greater Direct Ownership InterestPresident Sep 6, 2017 50%
General Partnership InterestPresident Sep 6, 2017 50%
Corporate OfficerPresident Sep 6, 2017 50%
Operational/Managerial ControlPresident Sep 6, 2017 50%

Owners & managing parties with NPI records 2

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

  • Rhonda Gerace Bergeron, APRN, FNP
    • Family Nurse Practitioner
    • Port Barre, LA
    • NPI 1336250182

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

    CMS ownership
  • Dustin Joseph Miller, NP-C
    • Family Nurse Practitioner
    • Port Barre, LA
    • NPI 1790235000

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1346755154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 HIGHWAY 742",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705700542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 SAIZAN AVENUE",
            "city": "PORT BARRE",
            "state": "LA",
            "postal_code": "70577",
            "telephone_number": "337-447-4027",
            "fax_number": "337-585-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIANA PRACTITIONERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-447-4027",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "2203783812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Barre, LA

Sources for this page

Verify at the official NPI Registry.