NPIMap

Organization Active NPI

CLHG-Oakdale LLC

Doing business as Family Medicine Associates of Oakdale

  • Rural Health Clinic/Center
  • Oakdale, LA
National Provider Identifier
1356932859
Registry record updated Dec 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLHG-OAKDALE LLC
Doing business as
Family Medicine Associates of Oakdale
Practice address
105 Hospital Dr
Oakdale, LA 71463-3034
Phone
(318) 335-4320
NPI assigned
Jan 28, 2021
Last updated
Dec 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2022

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

Authorized official

Name
Rock Bordelon
Title
Ceo
Phone
(318) 226-8202

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

105 Hospital Dr
Oakdale, LA 71463-3034

Mailing address

130 Hospital Dr
Oakdale, LA 71463-3035

Other names 1

  • Family Medicine Associates of Oakdale Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181116002285 LA Part B Supplier - Clinic/Group Practice 1355623943 Receives reassigned benefits from 71 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oakdale, LA; Oberlin, LA
O20210726003381 LA Part A Provider - Rural Health Clinic 1355623943 Practice locations: Oakdale, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356932859. Details of each certification follow.

Rural health clinic certification: CCN 198540

Legal name
CLHG-OAKDALE LLC
Doing business as
FAMILY MEDICINE ASSOCIATES OF OAKDALE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 25, 2022
Last certification
Apr 25, 2022
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
105 Hospital Dr
Oakdale, LA 71463-3034
Related CCNs
190106

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

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 2

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
19D0714664Family Medicine Associates of Oakdale105 N Hospital Drive, Oakdale, LA 71463Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Oakdale LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

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
Donald Cameron Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 11%
Corporate Officer Sep 1, 2016
W-2 Managing Employee Sep 1, 2016
Rock Bordelon Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 65%
Corporate OfficerBoard Member Sep 1, 2016
Allegiance Health Management Inc Organization, Bossier City, LA Corporation, Management services company, Chain home office Operational/Managerial Control Sep 1, 2016
Kevin Ardoin Individual Corporate Officer May 26, 2023
W-2 Managing Employee May 26, 2023
Operational/Managerial Control May 26, 2023
Scott Markstrom Individual 5% Or Greater Direct Ownership Interest Sep 1, 2016 8%
Corporate OfficerBoard Member Sep 1, 2016
Cameron Investments LLC Organization, Shreveport, LA LLC 5% Or Greater Direct Ownership Interest Sep 1, 2016 16%

Facilities with the same owner 53

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 53

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670889600000",
    "number": "1356932859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 HOSPITAL DR",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714633035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HOSPITAL DR",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714633034",
            "telephone_number": "318-335-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-OAKDALE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-28",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A",
        "authorized_official_last_name": "BORDELON",
        "authorized_official_first_name": "ROCK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-226-8202"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Associates of Oakdale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakdale, LA

Sources for this page

Verify at the official NPI Registry.