Organization Active NPI

Abbeville General Hospital

Doing business as Maurice Community Care Clinic

Rural Health Clinic/Center
Maurice, LA

National Provider Identifier

1447301437

Registry record updated Nov 10, 2020

On this page

Key facts
NPPES NPI Registry
Medicare participation
Laboratory certificates & supplier records
National Provider Directory
Ownership & related parties
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Maurice, LA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Rural Health Clinic/CenterTaxonomy code 261QR1300X
License: 160RHC-2 Issued in LA
Legal business name: ABBEVILLE GENERAL HOSPITAL
Doing business as: Maurice Community Care Clinic
Practice address: 207 Milton Rd
Maurice, LA 70555
Phone: (337) 898-9449
Fax: (337) 898-9556
NPI assigned: Jan 16, 2007
Last updated: Nov 10, 2020By the provider in NPPES
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Authorized official

Name: Mr. Ray Landry
Title: Ceo
Phone: (337) 893-5466

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Rural Health Clinic/Center	261QR1300X	160RHC-2	LA	Primary

Addresses

Primary practice location

207 Milton Rd
Maurice, LA 70555

Mailing address

118 N Hospital Dr
Abbeville, LA 70510-4039
Phone (337) 893-5466

Other identifiers 1

Identifier	Type	State	Issuer
1012050	Medicaid	LA

Other names 1

Maurice Community Care Clinic Doing business as

Electronic endpoints 3

Type	Endpoint	Use
Direct Messaging Address	ABBGREGORYFONTENOT@abbgen.cernerdirect.com	Direct
Direct Messaging Address	ABBMELISAHARRINGTON@abbgen.cernerdirect.com	Direct
Direct Messaging Address	ABBJULIERATLIFF@abbgen.cernerdirect.com	Direct

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in LA

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20070226000487	LA	Part A Provider - Rural Health Clinic	8325933872	Practice locations: Maurice, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447301437. Details of each certification follow.

CCN 193472 Rural health clinic · Active · Details

Rural health clinic certification: CCN 193472

Legal name: ABBEVILLE GENERAL HOSPITAL
Doing business as: MAURICE COMMUNITY CARE CLINIC
Certification status: Active
Provider type (POS): Rural health clinic
Participating since: Jun 18, 2007
Last certification: Oct 29, 2018
Ownership / control type: Non-profit – church related
Organization structure: OtherNon-profit
Enrollment address: 207 Milton Rd
Maurice, LA 70555-4448
Related CCNs: 190034

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

Abbeville General Hospital
- Rural Acute Care Hospital
- Abbeville, LA
- NPI 1255300414
Parent provider
Provider of Services

Other NPIs with the same Medicare PAC ID 6

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

Abbeville General Hospital
- Rural Acute Care Hospital
- Abbeville, LA
- NPI 1255300414
8325933872
Same PAC ID
Abbeville General Hospital
- Clinic/Center
- Abbeville, LA
- NPI 1285779363
8325933872
Same PAC ID
Abbeville General Hospital

dba Abbeville Urgent Care
- Urgent Care Clinic/Center
- Abbeville, LA
- NPI 1619458247
8325933872
Same PAC ID
Abbeville General Hospital
- Psychiatric Hospital Unit
- Abbeville, LA
- NPI 1619936580
8325933872
Same PAC ID
Abbeville General Hospital
- Rural Health Clinic/Center
- Erath, LA
- NPI 1700129749
8325933872
Same PAC ID
Abbeville General Hospital

dba Abbeville General Hospital Clinic
- Rural Health Clinic/Center
- Abbeville, LA
- NPI 1790744506
8325933872
Same PAC ID

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 number	Laboratory	Certificate	Expires
19D1063915	Maurice Community Care Clinic207 Milton Rd, Maurice, LA 70555	Certificate of waiver	Jan 23, 2027

National Provider Directory

Interoperability endpoints

Direct secure messaging: abbgregoryfontenot@abbgen.cernerdirect.com
Direct secure messaging: abbjulieratliff@abbgen.cernerdirect.com
Direct secure messaging: abbmelisaharrington@abbgen.cernerdirect.com

Ownership & related parties

All disclosed owners & managing parties 7

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

Name	Role	Since
Chuck E Guidry Individual	Corporate OfficerCio	Feb 22, 2022
Dondi Arceneaux Individual	Corporate OfficerSupport Services Director	Feb 22, 2022
Heidi C Broussard Individual	Corporate OfficerCno	Feb 22, 2022
Thomas Pigott Individual	Corporate OfficerCoo	Feb 22, 2022
Brittany L Thibodeaux Individual	Corporate OfficerCqo	Feb 22, 2022
Michael Bertrand Individual	Corporate OfficerCeo	May 2, 2022
Michael Bertrand Individual	Corporate DirectorCeo	May 2, 2022
William Troy Hair Individual	W-2 Managing Employee	Feb 22, 2022

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Facility	Type	Role	Since
Erath-Delcambre Community Care ClinicErath, LA, CCN 193490	Rural health clinic	5% Or Greater Direct Ownership Interest (100%)	Feb 1, 1966

Owned or controlled facilities with NPI records 1

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

Abbeville General Hospital
- Rural Health Clinic/Center
- Erath, LA
- NPI 1700129749
5% Or Greater Direct Ownership Interest
CMS ownership

Practitioners & affiliated clinicians

Practitioners 3

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.

Ronald Myron Lahasky, M.D.
- Internal Medicine Physician
- Abbeville, LA
- NPI 1487768214
NPD
Wade Dewayne Alexander, NP
- Nurse Practitioner
- New Iberia, LA
- NPI 1841785102
NPD (past)
Jennifer Coleman, FNP
- Family Nurse Practitioner
- Donaldsonville, LA
- NPI 1275995367
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1447301437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 N HOSPITAL DR",
            "city": "ABBEVILLE",
            "state": "LA",
            "postal_code": "705104039",
            "telephone_number": "337-893-5466",
            "fax_number": "337-893-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 MILTON RD",
            "city": "MAURICE",
            "state": "LA",
            "postal_code": "70555",
            "telephone_number": "337-898-9449",
            "fax_number": "337-898-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABBEVILLE GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A",
        "authorized_official_last_name": "LANDRY",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-893-5466",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "160RHC-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012050",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ABBGREGORYFONTENOT@abbgen.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Abbeville General- Maurice Community Care Clinic Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "207 Milton Rd",
            "city": "Maurice",
            "state": "LA",
            "country_code": "US",
            "postal_code": "70555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ABBMELISAHARRINGTON@abbgen.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Abbeville General- Maurice Community Care Clinic Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "207 Milton Rd",
            "city": "Maurice",
            "state": "LA",
            "country_code": "US",
            "postal_code": "70555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ABBJULIERATLIFF@abbgen.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Abbeville General- Maurice Community Care Clinic Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "207 Milton Rd",
            "city": "Maurice",
            "state": "LA",
            "country_code": "US",
            "postal_code": "70555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Maurice Community Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maurice Community Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maurice, LA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.