NPIMap

Organization Active NPI

Rayville Family Clinic LLC

  • Rural Health Clinic/Center
  • Rayville, LA
National Provider Identifier
1366672016
Registry record updated Jan 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
157 Issued in LA
Legal business name
RAYVILLE FAMILY CLINIC LLC
Practice address
1962 Julia St
Rayville, LA 71269-5527
Phone
(318) 728-8833
Fax
(318) 728-8940
NPI assigned
Jul 15, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2012

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

Authorized official

Name
Mr. Joseph F Sylvestri Sr.
Title
Owner
Phone
(318) 728-8833

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X
Rural Health Clinic/Center 261QR1300X 157 LA Primary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1962 Julia St
Rayville, LA 71269-5527

Mailing address

PO Box 658
Rayville, LA 71269-0658
Phone (318) 728-8833

Other identifiers 1

IdentifierTypeStateIssuer
1808440MedicaidLA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100329000086 LA Part B Supplier - Clinic/Group Practice 8426184516 Receives reassigned benefits from 4 practitioners
Practice locations: Rayville, LA
O20110304000760 LA Part A Provider - Rural Health Clinic 8426184516 Practice locations: Rayville, LA

Rural health clinic certification: CCN 193900

Legal name
RAYVILLE FAMILY CLINIC LLC
Doing business as
RAYVILLE FAMILY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 4, 2011
Last certification
Oct 3, 2022
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
1962 Julia Street
Rayville, LA 71269-5527

National Provider Directory

National Provider Directory
Tax ID family
Rayville Family Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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
Joseph Sylvestri Individual 5% Or Greater Direct Ownership Interest Jun 29, 2009 50%
Corporate DirectorCeo Jun 29, 2009 100%
Terri H Sylvestri Individual 5% Or Greater Direct Ownership Interest Jun 29, 2009 50%
W-2 Managing EmployeeHouse Supervisor, Nurse Practiti Jun 29, 2009 100%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1366672016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "712690658",
            "telephone_number": "318-728-8833",
            "fax_number": "318-728-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1962 JULIA ST",
            "city": "RAYVILLE",
            "state": "LA",
            "postal_code": "712695527",
            "telephone_number": "318-728-8833",
            "fax_number": "318-728-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAYVILLE FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-15",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "SYLVESTRI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-728-8833",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "157",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1808440",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rayville, LA

Sources for this page

Verify at the official NPI Registry.