Country Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

025398 Issued in LA

Legal business name

COUNTRY CLINIC, LLC

Practice address

314 Christine LN
Simmesport, LA 71369-2256

Phone

(318) 941-2057

Fax

(318) 941-2067

NPI assigned

May 8, 2006

Last updated

Nov 13, 2014By 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

Mrs. Rose Kuplesky, RN

Title

Owner/Manager

Phone

(318) 941-2057

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

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

CLIA laboratory certificates

Locations

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.

• Christopher L Surek, D.O.

  • Family Medicine Physician
  • Deerfield, IL
  • NPI 1336119858

  LA

  Medicare reassignment Care Compare group NPD
• Gordon Ellis White II, M.D.

  • Military Health Care Provider
  • Danville, IL
  • NPI 1639169485

  Family Medicine, LA

  Medicare reassignment Care Compare group NPD
• Brian A Heise, MD

  • Family Medicine Physician
  • Baton Rouge, LA
  • NPI 1679547038
  Medicare reassignment NPD

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415836800000",
    "number": "1609825892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80735",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705980735",
            "telephone_number": "800-564-8971",
            "fax_number": "866-693-1704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 CHRISTINE LN",
            "city": "SIMMESPORT",
            "state": "LA",
            "postal_code": "713692256",
            "telephone_number": "318-941-2057",
            "fax_number": "318-941-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2014-11-13",
        "status": "A",
        "authorized_official_last_name": "KUPLESKY",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "318-941-2057",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "025398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1445665",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bayou Chateau Nursing Center, Inc (Bayou Chateau Nursing Center)
• Kellie Roy Bertrand, CFNP
• Finecia Renee Draper, PSY. M.
• Firmin Family Health Clinics LLC (Firmin Family Care)
• Crystal G Firmin, NP-C
• Krista Johnson
• KD Health & Wellness Center LLC

• Family Medicine Physician in Simmesport, LA
• Providers in Simmesport, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.