NPIMap

Organization Active NPI

Professional Pediatrics, LLC

Doing business as The Pediatric Center

  • Rural Health Clinic/Center
  • Leesville, LA
National Provider Identifier
1376717959
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PROFESSIONAL PEDIATRICS, LLC
Doing business as
The Pediatric Center
Practice address
919 S 10TH St
Leesville, LA 71446-4613
Phone
(337) 239-2207
NPI assigned
Apr 15, 2008
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Robert CroweNPI 1790774958
Title
Physician
Phone
(337) 238-0777

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
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

919 S 10TH St
Leesville, LA 71446-4613

Mailing address

PO Box 130
Newllano, LA 71461-0130

Other identifiers 1

IdentifierTypeStateIssuer
2114841MedicaidLA

Other names 1

  • The Pediatric Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080711000328 LA Part B Supplier - Clinic/Group Practice 5698847317 Receives reassigned benefits from 8 practitioners
Practice locations: Leesville, LA
O20190909003509 LA Part A Provider - Rural Health Clinic 5698847317 Practice locations: Leesville, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376717959. Details of each certification follow.

Rural health clinic certification: CCN 193960

Legal name
PROFESSIONAL PEDIATRICS, LLC
Doing business as
THE PEDIATRIC CENTER AND SABINE URGENT CARE OF LEESVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 4, 2020
Last certification
May 4, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jan 7, 2008 in LA
Enrollment address
919 South 10TH Street
Leesville, LA 71446-4613

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
19D1086156Pediatric Center the919 South 10TH Street, Leesville, LA 71446ComplianceMay 19, 2027

National Provider Directory

National Provider Directory

Locations

802 S 10th St
Ste C
Leesville, LA 71446
Phone (337) 238-4189

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Allison Crowe Individual 5% Or Greater Direct Ownership InterestManaging Member of LLC Jan 7, 2008 50%
Robert F Crowe Individual 5% Or Greater Direct Ownership InterestManaging Member of LLC Jan 7, 2008 50%
Crowe Family LLC Organization, Leesville, LA Created for acquisition, LLC 5% Or Greater Mortgage Interest May 17, 2012 100%
Chelsea Thompson Individual W-2 Managing EmployeeChelsea Thompson, Practice Manag Jul 29, 2019

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 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1376717959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "NEWLLANO",
            "state": "LA",
            "postal_code": "714610130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 S 10TH ST",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464613",
            "telephone_number": "337-239-2207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "CROWE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "337-238-0777"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2114841",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pediatric Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Pediatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesville, LA

Sources for this page

Verify at the official NPI Registry.