Rural Health Clinic of Loreauville LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

RURAL HEALTH CLINIC OF LOREAUVILLE LLC

Practice address

411 South Main St.
Loreauville, LA 70552

Phone

(337) 229-8288

NPI assigned

Jun 28, 2013

Last updated

Nov 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brock J Romero, NPNPI 1841576477

Title

Sole Member

Phone

(337) 229-8288

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508206020. Details of each certification follow.

• CCN 193833 Rural health clinic · Active · Details

Rural health clinic certification: CCN 193833

Legal name

RURAL HEALTH CLINIC OF LOREAUVILLE LLC

Doing business as

RURAL HEALTH CLINIC OF LOREAUVILLE

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 23, 1996

Last certification

Jun 12, 2018

Ownership / control type

1A

Most recent change of ownership

Feb 20, 2014 (1 total)

Organization structure

LLCProprietary

Enrollment address

411 South Main Street
Loreauville, LA 70552-0278

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• Brock Jude Romero, APRN

  • Family Nurse Practitioner
  • Loreauville, LA
  • NPI 1841576477

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Practitioners 4

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.

• Brock Jude Romero, APRN

  • Family Nurse Practitioner
  • Loreauville, LA
  • NPI 1841576477
  Medicare reassignment Authorized official
• Patrick Shawn Baquet, M.D.

  • Family Medicine Physician
  • New Iberia, LA
  • NPI 1326078577
  Medicare reassignment NPD
• Glen Paul Carbo, FNP

  • Family Nurse Practitioner
  • Lafayette, LA
  • NPI 1598724585
  NPD (past)
• Brandie Marie Ponder, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • Thibodaux, LA
  • NPI 1588856918
  NPD (past)

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

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1508206020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "LOREAUVILLE",
            "state": "LA",
            "postal_code": "705520278",
            "telephone_number": "337-229-8288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 SOUTH MAIN ST.",
            "city": "LOREAUVILLE",
            "state": "LA",
            "postal_code": "70552",
            "telephone_number": "337-229-8288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CLINIC OF LOREAUVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-28",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "ROMERO",
        "authorized_official_first_name": "BROCK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "337-229-8288",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Jude Bayard, A.P.R.N, F.N.P-C.
• Alison Broussard, CCC-SLP
• James R Romero MD a Medical Corporation
• Brock Jude Romero, APRN
• Thanna Gail C Leleux (Leleuxs Pharmacy)
• Village Pharmacy & Wellness

• Rural Health Clinic/Center in Loreauville, LA
• Providers in Loreauville, LA by specialty
• Rural Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.