Primary Care Providers for a Healthy Feliciana, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Jackson, LA
NPI 1437258043 · NPPES record last updated Apr 12, 2022
Key facts
- NPI
- 1437258043
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.
- Practice address
- 3619 Highway 10
Jackson, LA 70748 - Phone
- (225) 683-1360
- Fax
- (225) 634-0005
- NPI assigned
- Sep 21, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
Authorized official
- Name
- Christi C Hunt
- Title
- Ceo
- Phone
- (225) 683-5292
Other NPIs on the same Medicare enrollment 11
Corporate family (same tax ID) 24
Practitioners 65
-
Bettie Blackmon, FNP-C
-
Robert Allen Carlisle, LPC-S
-
Dominique Nicole Debetaz, LCSW
-
Dale Valerie Haase, LCSW
-
Ruby D Pizzolato, LCSW
-
Cynthia Bourgeois Abed, LCSW-BACS
-
Marie M Attuso, MD
-
Kelly Bankston, APRN
-
Amanda Barfield, APRN, PMHNP-BC
-
Cindy Parks Bennett, LCSW-BACS
-
Jonathan Roy Blanton, LCSW
-
Lindsey Cress Bofinger, F.N.P.
-
Stella E Brown, LCSW, BCSAC
-
Jai Sharra Lianne Bryant, NP-C
-
Katie A Camp, PMHNP
-
John Gary Chaney, APMHNP-BC
-
Allison B Coleman, LCSW
-
Tiffany Ann Cologne, LPC, NCC
-
Haley B David, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Federally qualified health center certification: CCN 191853
- Legal name
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
- Doing business as
- JACKSON COMPLEX HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 9, 2007
- Last certification
- Jul 9, 2007
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 6, 1998 in LA
- Enrollment address
- 3619 Highway 10
Jackson, LA 70748
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Richard C Holton |
Corporate Director |
Oct 25, 2007 | |
| Alfreda D Jackson |
Corporate Director |
Sep 29, 2009 | |
| Veronica D Easterly |
Corporate Director |
Sep 30, 2010 | |
| Kenny Sanders |
Corporate Director |
Sep 22, 2011 | |
| Christi C Hunt |
Corporate Officer |
Oct 17, 2020 | 100% |
| W-2 Managing Employee |
Oct 17, 2020 | 100% | |
| Operational/Managerial Control |
Oct 17, 2020 | 100% | |
| Virdie Moeller |
Corporate Director |
Mar 28, 2013 | |
| Nicole C Wilcher |
Corporate Director |
Mar 28, 2013 | |
| Louis J Kent |
Corporate Director |
Aug 6, 1998 | |
| Columbus Hutchinson |
Corporate Director |
Mar 29, 2018 | |
| Anita P Cambre |
Corporate Director |
Oct 25, 2007 | |
| Mark Kemp |
Corporate Director |
Mar 28, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040224000173 | LA | Part B Supplier - Clinic/Group Practice | 1052220985 |
Receives reassigned benefits from 99 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Springfield, LA; Slaughter, LA; Port Allen, LA; Jackson, LA; Loranger, LA; Clinton, LA; Baton Rouge, LA; Livingston, LA |
| O20070509000584 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 1052220985 | Practice locations: Jackson, LA |
National Provider Directory
- Tax ID family
- Primary Care Providers for a Healthy Feliciana Inc
- Part of
- Primary Care Providers for a Healthy Feliciana Inc
Locations
3501 Highway 10
Jackson, LA 70748
Phone (225) 683-1360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | LA | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
3619 Highway 10
Jackson, LA 70748
Mailing address
P.O. Box 395
Clinton, LA 70722-0395
Phone (225) 683-5292
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1448389 | Medicaid | LA |
Other names
- Jackson Complex Health Center
Other providers in Jackson, LA
- Gabriel I Onor Sr.
- Robert William Papcsy III
- Waylon Morris Parker
- Alan Ray Perego
- Wanda Lynn Pezant
- Joshua A Primeaux
- R.C.McDonald Co Inc
- S.O.P.E. Transportation, LLC
- Dahn Savell
- Latasha Dinyel Shavers
All providers in Jackson, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.