NPIMap

Organization Active NPI

St. Martin Hospital, Inc.

  • Rural Health Clinic/Center
  • Breaux Bridge, LA
National Provider Identifier
1407414816
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. MARTIN HOSPITAL, INC.
Practice address
1555 Gary Dr Ste C
Breaux Bridge, LA 70517-3448
Phone
(337) 909-2460
NPI assigned
May 31, 2019
Last updated
Mar 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. MARTIN HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Karen Wyble
Title
Ceo
Phone
(337) 332-2178

Specialties & licenses 1

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

Addresses

Primary practice location

1555 Gary Dr Ste C
Breaux Bridge, LA 70517-3448

Mailing address

210 Champagne Blvd
Breaux Bridge, LA 70517-3700
Phone (337) 507-1201

Other names 1

  • St. Martin Hospital Community Health Clinic Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200413001606 LA Part A Provider - Rural Health Clinic 4688720782 Practice locations: Breaux Bridge, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407414816. Details of each certification follow.

Rural health clinic certification: CCN 198531

Legal name
ST MARTIN HOSPITAL INC
Doing business as
OCSHNER ST. MARTIN HOSPITAL COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 15, 2021
Last certification
Jan 15, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 2, 2009 in LA
Enrollment address
1555 Gary Dr
Ste C
Breaux Bridge, LA 70517-3448
Related CCNs
191302

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
St Martin Hospital Inc7 organizations share this tax ID, including this one
Part of
St Martin Hospital Inc

Other organizations with this tax ID 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Ramesh Kolluru Individual Corporate DirectorBoard Member Aug 30, 2022
Christopher P Rader Individual Corporate DirectorBoard Member Jan 31, 2023
Burton Dupuis Individual Corporate Director Feb 1, 2020
Frank L Walker Individual Corporate DirectorBoard Member Feb 1, 2017
Lafayette General Health System Inc Organization, Lafayette, LA Corporation, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 1, 2020 100%
Operational/Managerial Control Feb 1, 2020
Peter C November Individual Corporate OfficerChief Executive Officer Nov 1, 2022
Reshma a Bhanushali Individual Corporate DirectorBoard Member Jan 31, 2023
St Martin Hospital Inc Organization, Breaux Bridge, LA Corporation, Medical provider/supplier, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2020
Operational/Managerial Control Feb 1, 2020
Edward Scott Yerger Individual Corporate DirectorBoard Member Jan 31, 2023
Warren J Degatur Individual Corporate Director Feb 1, 2020
Patrick Gandy Individual Corporate OfficerChief Executive Officer (LGHS) Feb 1, 2020
James M Molloy Individual Corporate OfficerEvp-Cfo & Treasurer Jan 1, 2024
Molly B Thomas Individual Corporate DirectorBoard Member Feb 1, 2018
Ochsner Clinic Foundation Organization, New Orleans, LA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2020 100%
Operational/Managerial Control Oct 1, 2020
Norman J Vascocu Individual Corporate DirectorBoard Member Aug 30, 2022
Timothy L. Riddell Individual Corporate OfficerExecutive VP - Coo (Ocf) Jan 1, 2026
Wayne B Cestia Individual Corporate DirectorBoard Member Feb 1, 2017
Jennifer Vicknair Individual Contracted Managing EmployeeAd; Jun 1, 2025
Operational/Managerial ControlAdministrator Jun 1, 2025
Mary Ellen Henry Individual Corporate DirectorBoard Member Feb 1, 2017
Casey Hoyt Individual Corporate DirectorBoard Member Aug 30, 2022
Al Patin Individual Corporate OfficerChief Executive Officer Jul 1, 2023

Owners & managing parties with NPI records 11

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

Facilities with the same owner 74

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

View all 74

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1407414816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 CHAMPAGNE BLVD",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705173700",
            "telephone_number": "337-507-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 GARY DR STE C",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705173448",
            "telephone_number": "337-909-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARTIN HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARTIN HOSPITAL, INC.",
        "enumeration_date": "2019-05-31",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "WYBLE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-332-2178"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "St. Martin Hospital Community Health Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St. Martin Hospital Community Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Breaux Bridge, LA

Sources for this page

Verify at the official NPI Registry.