NPIMap

Organization Active NPI

North Caddo Hospital Service District

Doing business as Plain Dealing Medical Clinic

  • Family Medicine Physician
  • Plain Dealing, LA
National Provider Identifier
1477798668
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTH CADDO HOSPITAL SERVICE DISTRICT
Doing business as
Plain Dealing Medical Clinic
Practice address
112 Forest Street
Plain Dealing, LA 71064-3446
Phone
(318) 326-7272
NPI assigned
Dec 3, 2008
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

Name
Mr. David Jones
Title
Ceo
Phone
(318) 375-4001

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02439R LA
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

112 Forest Street
Plain Dealing, LA 71064-3446

Mailing address

112 N Forrest Rd
Plain Dealing, LA 71064-4031
Phone (318) 326-7272

Other identifiers 2

IdentifierTypeStateIssuer
1444286MedicaidLA
2302639MedicaidLA

Other names 1

  • Plain Dealing Medical Clinic Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kayciwilson@ncmc.allscriptsdirect.net Direct
Direct Messaging Address nicolemccommon@ncmc.allscriptsdirect.net Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090327000225 LA Part A Provider - Rural Health Clinic 4385544584 Practice locations: Plain Dealing, LA
O20090424000082 LA Part B Supplier - Clinic/Group Practice 4385544584 Receives reassigned benefits from 19 practitioners
Practice locations: Plain Dealing, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477798668. Details of each certification follow.

Rural health clinic certification: CCN 193485

Legal name
NORTH CADDO HOSPITAL SERVICE DISTRICT
Doing business as
NCMC PLAIN DEALING MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 9, 2011
Last certification
Nov 2, 2021
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
112 Forest Street
Plain Dealing, LA 71064-0001
Related CCNs
191304

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Locations

112 N Forrest Rd
Plain Dealing, LA 71064
Phone (318) 326-7272

Interoperability endpoints

  • Direct secure messaging: kayciwilson@ncmc.allscriptsdirect.net

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
Dakota Robinson Individual Corporate DirectorCfo Oct 28, 2018
Operational/Managerial ControlCfo Oct 28, 2018
Thomas Tebbe Individual Corporate Officer Feb 1, 2024
Robert Green Individual Corporate Director Jan 1, 2009
North Caddo Hospital Service District Organization, Vivian, LA 5% Or Greater Direct Ownership Interest Nov 1, 2017
Operational/Managerial Control Nov 1, 2017
Michael Nation Individual Corporate Officer Aug 5, 2021
Jennifer Fant Individual Corporate Officer Jun 7, 2022
David Jones Individual Corporate Director Jan 1, 2009
Brenda Smith Individual Corporate Officer Sep 6, 2001
Kenneth Cochran Individual Corporate Officer Jul 19, 2018
David Norman Individual Corporate Director Jan 1, 2021
Mary Irvin Individual Corporate Director Jan 1, 2009

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
North Caddo Medical CenterVivian, LA, CCN 19Z304 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2001
NCMC Medical & Surgical ClinicVivian, LA, CCN 193476 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 2, 2008
Jan 2, 2008
Benton MedicalBenton, LA, CCN 198513 Rural health clinic Operational/Managerial Control (100%) Nov 3, 2015
Blanchard MedicalShreveport, LA, CCN 198536 Rural health clinic Other (100%) Jan 1, 2021
South Bossier MedicalBossier City, LA, CCN 198549 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1477798668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N FORREST RD",
            "city": "PLAIN DEALING",
            "state": "LA",
            "postal_code": "710644031",
            "telephone_number": "318-326-7272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 FOREST STREET",
            "city": "PLAIN DEALING",
            "state": "LA",
            "postal_code": "710643446",
            "telephone_number": "318-326-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CADDO HOSPITAL SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-375-4001",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "02439R",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1444286",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2302639",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kayciwilson@ncmc.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Plain Dealing Medical - kayciwilson@ncmc.allscriptsdirect.net",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "112 Forest Street",
            "city": "Plain Dealing",
            "state": "LA",
            "country_code": "US",
            "postal_code": "710643446",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicolemccommon@ncmc.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Plain Dealing Medical - nicolemccommon@ncmc.allscriptsdirect.net",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "112 Forest Street",
            "city": "Plain Dealing",
            "state": "LA",
            "country_code": "US",
            "postal_code": "710643446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Plain Dealing Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Plain Dealing Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plain Dealing, LA

Sources for this page

Verify at the official NPI Registry.