NPIMap

Organization Active NPI

Primary Care Providers for a Healthy Feliciana, Inc.

Doing business as Jackson Complex Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, LA
National Provider Identifier
1437258043
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.
Doing business as
Jackson Complex Health Center
Practice address
3619 Highway 10
Jackson, LA 70748
Phone
(225) 683-1360
Fax
(225) 634-0005
NPI assigned
Sep 21, 2006
Last updated
Apr 12, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Authorized official

Name
Christi C Hunt
Title
Ceo
Phone
(225) 683-5292

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X LA
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 names 1

  • Jackson Complex Health 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
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437258043. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Aug 6, 1998 in LA
Enrollment address
3619 Highway 10
Jackson, LA 70748

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
RKM Primary72 organizations share this tax ID, including this one
Part of
RKM Primary

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Richard C Holton Individual Corporate DirectorBoard Member Oct 25, 2007
Alfreda D Jackson Individual Corporate DirectorBoard Member Sep 29, 2009
Veronica D Easterly Individual Corporate DirectorBoard Member Sep 30, 2010
Kenny Sanders Individual Corporate DirectorBoard Member Sep 22, 2011
Christi C Hunt Individual Corporate OfficerCeo Oct 17, 2020 100%
W-2 Managing EmployeeCeo Oct 17, 2020 100%
Operational/Managerial ControlCeo Oct 17, 2020 100%
Virdie Moeller Individual Corporate DirectorBoard Member Mar 28, 2013
Nicole C Wilcher Individual Corporate DirectorBoard Member Mar 28, 2013
Louis J Kent Individual Corporate DirectorBoard Member Aug 6, 1998
Columbus Hutchinson Individual Corporate DirectorBoard Member Mar 29, 2018
Anita P Cambre Individual Corporate DirectorBoard Member Oct 25, 2007
Mark Kemp Individual Corporate DirectorBoard Member Mar 28, 2013

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1437258043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 395",
            "city": "CLINTON",
            "state": "LA",
            "postal_code": "707220395",
            "telephone_number": "225-683-5292",
            "fax_number": "225-683-1310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3619 HIGHWAY 10",
            "city": "JACKSON",
            "state": "LA",
            "postal_code": "70748",
            "telephone_number": "225-683-1360",
            "fax_number": "225-634-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC",
        "enumeration_date": "2006-09-21",
        "last_updated": "2022-04-12",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "CHRISTI",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-683-5292"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Complex Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson Complex Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, LA

Sources for this page

Verify at the official NPI Registry.