NPIMap

Organization Active NPI

Calcasieu Cameron Hospital Service District

Doing business as Johnson Bayou Rural Health Clinic

  • Rural Health Clinic/Center
  • Cameron, LA
National Provider Identifier
1396930335
Registry record updated Jan 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Doing business as
Johnson Bayou Rural Health Clinic
Practice address
6240 Gulf Beach Hwy
Cameron, LA 70631-4213
Phone
(337) 527-6530
NPI assigned
Sep 12, 2007
Last updated
Jan 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2020

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

Authorized official

Name
Jobie James
Title
Cfo
Phone
(337) 527-4143

Specialties & licenses 1

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

Addresses

Primary practice location

6240 Gulf Beach Hwy
Cameron, LA 70631-4213

Mailing address

6240 Gulf Beach Hwy
Cameron, LA 70631-4213

Other identifiers 1

IdentifierTypeStateIssuer
1824879MedicaidLA

Other names 1

  • Johnson Bayou Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080908000234 LA Part A Provider - Rural Health Clinic 1052221447 Practice locations: Johnson Bayou, LA
O20081104000079 LA Part B Supplier - Clinic/Group Practice 1052221447 Receives reassigned benefits from 60 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sulphur, LA; Vinton, LA; Hackberry, LA; Cameron, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396930335. Details of each certification follow.

Rural health clinic certification: CCN 193479

Legal name
CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT
Doing business as
JOHNSON BAYOU RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 3, 2009
Last certification
Jan 5, 2022
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
6240 Gulf Beach Hwy
Johnson Bayou, LA 70631-4213
Related CCNs
190013

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 11

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
19D1077687Johnson Bayou Rural Health Clinic6240 Gulf Beach Hwy, Johnsons Bayou, LA 70631Certificate of waiverDec 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
West Calca Sieu Cameron15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Interoperability endpoints

  • Direct secure messaging: jodygeorge@wcj.allscriptsdirect.net
  • Direct secure messaging: reginabougie@wcj.allscriptsdirect.net

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Calcasieu Cameron Hospital Service District Organization, Sulphur, LA Operational/Managerial Control Nov 16, 2007 100%
Robert Letard Individual Corporate DirectorBoard Member Feb 22, 2005 20%
Janie Fruge Individual Corporate OfficerCeo Jul 1, 2013 100%
W-2 Managing EmployeeCeo Jul 1, 2013 100%
Operational/Managerial ControlCeo Jul 1, 2013 100%
Jobie James Individual Corporate OfficerCfo May 5, 2014 100%
W-2 Managing EmployeeCfo May 5, 2014 100%
Operational/Managerial ControlCfo May 5, 2014 100%
Mark McMurry Individual Corporate DirectorBoard Member Dec 1, 2022 20%
Robert Davidson Individual Corporate DirectorBoard Member Jan 25, 2000 20%
Cecil Sanner Individual Corporate DirectorBoard Member Aug 1, 2024 20%
Ellis Hassien Individual Corporate DirectorBoard Member Apr 1, 2025 20%

Owners & managing parties with NPI records 4

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
West Calcasieu Cameron HospitalSulphur, LA, CCN 190013 Hospital Operational/Managerial Control (100%) Mar 1, 2013

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1396930335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6240 GULF BEACH HWY",
            "city": "CAMERON",
            "state": "LA",
            "postal_code": "706314213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6240 GULF BEACH HWY",
            "city": "CAMERON",
            "state": "LA",
            "postal_code": "706314213",
            "telephone_number": "337-527-6530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALCASIEU CAMERON HOSPITAL SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-12",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "JOBIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-527-4143"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1824879",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson Bayou Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Johnson Bayou Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cameron, LA

Sources for this page

Verify at the official NPI Registry.