NPIMap

Organization Active NPI

Mercy Medical Health Center

Doing business as Mercy Dental

  • Federally Qualified Health Center (FQHC)
  • Ruston, LA
National Provider Identifier
1346907086
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MERCY MEDICAL HEALTH CENTER
Doing business as
Mercy Dental
Practice address
900 S Vienna St
Ruston, LA 71270-5830
Phone
(318) 251-0334
NPI assigned
Nov 17, 2021
Last updated
Jun 26, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY MEDICAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Authorized official

Name
Kimberly G. Brunson, APRNNPI 1477785798
Title
Ceo
Phone
(318) 259-1100

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 1

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

Addresses

Primary practice location

900 S Vienna St
Ruston, LA 71270-5830

Mailing address

PO Box 70
Hodge, LA 71247-0070
Phone (318) 259-1100

Other names 1

  • Mercy Dental Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170614000398 LA Part B Supplier - Clinic/Group Practice 1557639655 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arcadia, LA; Jonesboro, LA; Ruston, LA
O20251114001419 LA Part A Provider - Federally Qualified Health Center (FQHC) 1557639655 Practice locations: Ruston, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346907086. Details of each certification follow.

Federally qualified health center certification: CCN 951002

Legal name
MERCY MEDICAL HEALTH CENTER
Doing business as
MERCY DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 21, 2025
Last certification
Aug 21, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
900 S Vienna St
Ruston, LA 71270-5830

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Mercy Medical Health Center7 organizations share this tax ID, including this one
Part of
Mercy Medical Health Center

Other organizations with this tax ID 6

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

Locations

600 N Highway 190
Ste 4
Covington, LA 70433
Phone (985) 893-5522

4629 Quitman Hwy
Hodge, LA 71247
Phone (318) 259-1100

4631 Quitman Hwy
Hodge, LA 71247
Phone (318) 475-3500

4633 Quitman Hwy
Hodge, LA 71247
Phone (318) 259-1100

900 S Vienna St
Ruston, LA 71270
Phone (318) 251-0334

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Mercy Medical Health Center Organization, Ruston, LA Non-profit Other Jan 1, 2022 100%
Kimberly Brunson Individual 5% Or Greater Direct Ownership InterestOwner Jan 22, 2018
W-2 Managing EmployeeCeo Jan 22, 2018
Operational/Managerial ControlCeo Jan 22, 2018
Rennata Becks Individual W-2 Managing EmployeeCoo May 1, 2017
Operational/Managerial ControlCoo May 1, 2017

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mercy Medical Health CenterJonesboro, LA, CCN 191007 Federally qualified health center Operational/Managerial Control (100%) Sep 5, 2017

Owned or controlled facilities with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1637107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1346907086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "HODGE",
            "state": "LA",
            "postal_code": "712470070",
            "telephone_number": "318-259-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S VIENNA ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705830",
            "telephone_number": "318-251-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY MEDICAL HEALTH CENTER",
        "enumeration_date": "2021-11-17",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "BRUNSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-259-1100",
        "authorized_official_credential": "APRN"
    },
    "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": "Mercy Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

Verify at the official NPI Registry.