NPIMap

Organization Active NPI

Capitol City Family Health Center, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Zachary, LA
National Provider Identifier
1609683937
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Practice address
20474 Old Scenic Hwy
Zachary, LA 70791-7365
Phone
(225) 478-1174
NPI assigned
Dec 11, 2024
Last updated
Dec 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Authorized official

Name
Matthew Valliere
Title
Ceo
Phone
(225) 650-2026

Specialties & licenses 1

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

Addresses

Primary practice location

20474 Old Scenic Hwy
Zachary, LA 70791-7365

Mailing address

PO Box 66156
Baton Rouge, LA 70896-6156
Phone (225) 650-2000

Other names 1

  • CareSouth Dermatology Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051130000101 LA Part B Supplier - Clinic/Group Practice 5193639151 Receives reassigned benefits from 94 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA; Zachary, LA; Shreveport, LA; Plaquemine, LA; Donaldsonville, LA
O20250307000715 LA Part A Provider - Federally Qualified Health Center (FQHC) 5193639151 Practice locations: Zachary, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609683937. Details of each certification follow.

Federally qualified health center certification: CCN 711033

Legal name
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Doing business as
CARESOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2025
Last certification
Feb 6, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
20474 Old Scenic Hwy
Zachary, LA 70791-7365

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Capitol Cy Fam HLTH Ctr Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Dalton Honore Individual Corporate DirectorBoard Member Oct 1, 2019
Edwin Walker Individual Corporate DirectorBoard Member Jun 1, 2018
Ruth Franklin Individual Corporate DirectorBoard Member Mar 1, 2016
Keisha Lacour Individual Corporate DirectorBoard Member Jun 1, 2022
Maimouna Keita Individual Corporate OfficerChief Financial Officer May 1, 2004
W-2 Managing EmployeeCfo May 1, 2004
Kenya Nelson Individual W-2 Managing EmployeeBilling Manager Jan 24, 2000
Richard Andrus Individual Corporate DirectorBoard Member Sep 14, 2014
Kerry Auzenne Individual Corporate DirectorBoard Member Oct 1, 2019
Debra Butler Individual Corporate DirectorBoard Member Jun 1, 2018
Brian Keith Bernard Individual Corporate DirectorBoard Member Jun 1, 2022
Shirley Lolis Individual Corporate DirectorBoard Member May 1, 2014
Darrin Dixon Individual Corporate DirectorBoard Member Jun 1, 2022
Elaine Patin Individual Corporate DirectorBoard Member Jun 1, 2018
Matthew Valliere Individual Corporate OfficerCeo Jan 19, 2016
W-2 Managing EmployeeCeo Jan 19, 2016
Edmond Jordan Individual Corporate DirectorBoard Member Mar 1, 2016

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Care SouthPlaquemine, LA, CCN 191943 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 10, 2014
CaresouthZachary, LA, CCN 191981 Federally qualified health center Other Dec 6, 1997

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1733875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1609683937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66156",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708966156",
            "telephone_number": "225-650-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20474 OLD SCENIC HWY",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707917365",
            "telephone_number": "225-478-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-11",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "VALLIERE",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-650-2026"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CareSouth Dermatology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Zachary, LA

Sources for this page

Verify at the official NPI Registry.