NPIMap

Organization Active NPI

David Raines Community Health Center, Inc.

Doing business as David Raines School Based Health Center-JS Clark

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
National Provider Identifier
1437673464
Registry record updated Aug 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Doing business as
David Raines School Based Health Center-JS Clark
Practice address
351 Hearne Ave
Shreveport, LA 71103-2019
Phone
(318) 425-8742
NPI assigned
Aug 1, 2017
Last updated
Aug 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2017

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

Authorized official

Name
Mr. Willie C. White III, CEO
Title
Chief Executive Officer
Phone
(318) 227-3350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

351 Hearne Ave
Shreveport, LA 71103-2019

Mailing address

3041 Martin Luther King Drive
Shreveport, LA 71107-4705
Phone (318) 227-3350

Other identifiers 1

IdentifierTypeStateIssuer
1941638MedicaidLA

Other names 1

  • David Raines School Based Health Center-JS Clark Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041007000508 LA Part B Supplier - Clinic/Group Practice 4688586118 Receives reassigned benefits from 67 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gilliam, LA; Shreveport, LA; Minden, LA; Keithville, LA; Hayneville, LA; Bossier City, LA
O20231102001758 LA Part A Provider - Federally Qualified Health Center (FQHC) 4688586118 Practice locations: Shreveport, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437673464. Details of each certification follow.

Federally qualified health center certification: CCN 191165

Legal name
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Doing business as
SBHC- J.S. CLARK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 25, 2023
Last certification
Oct 25, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 31, 2017 in LA
Enrollment address
351 Hearne Ave
Shreveport, LA 71103-2019

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 20

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

View all 20

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
19D2107709David Raines Community Health Center-SBHC-JS Clark351 Hearne Avenue, Shreveport, LA 71103Certificate of waiverJan 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
David Raines Community Health Center26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

128 Homer Rd
Minden, LA 71055
Phone (318) 377-1545

1625 David Raines Rd
Unit 2
Shreveport, LA 71107
Phone (318) 425-2252

7340 Wyngate Blvd
Shreveport, LA 71106
Phone (318) 687-4812

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
Darrell Webb Individual Corporate OfficerBoard Jan 1, 2026
Gladys Bush Individual Corporate OfficerTreasurer Jan 1, 2026
Deeandriez Wallace Individual Corporate DirectorBoard Mar 1, 2022
Stephen F Wright Individual Corporate DirectorBoard Mar 1, 2022
Fredrick Wilson Individual Corporate DirectorBoard Mar 1, 2022
Kenya Roberts Individual Corporate OfficerBoard Jan 1, 2026
Willie C White Individual Corporate DirectorCeo May 1, 1997
W-2 Managing EmployeeCeo May 1, 1997
Todd Hollenshead Individual Corporate Director Mar 1, 2022
Myrtis Edwards Individual Corporate OfficerCoo Nov 6, 2001
Janice Sneed Individual Corporate OfficerBoard Jan 1, 2026
Ryan Williams Individual Corporate DirectorBoard Mar 1, 2022

Practitioners & affiliated clinicians

Practitioners 6

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": "1501545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501545600000",
    "number": "1437673464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 MARTIN LUTHER KING DRIVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711074705",
            "telephone_number": "318-227-3350",
            "fax_number": "318-222-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711032019",
            "telephone_number": "318-425-8742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID RAINES COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-01",
        "last_updated": "2017-08-01",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "318-227-3350",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1941638",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David Raines School Based Health Center-JS Clark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.