NPIMap

Organization Active NPI

Acadiana Practitioners LLC

  • Rural Health Clinic/Center
  • Opelousas, LA
National Provider Identifier
1649084401
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACADIANA PRACTITIONERS LLC
Practice address
1200 Hospital Dr Ste 4
Opelousas, LA 70570-6552
Phone
(337) 948-7090
NPI assigned
Feb 3, 2025
Organization subpart
Yes
Parent organization
ACADIANA PRACTITIONERS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Authorized official

Name
Taylor Stevens
Title
Manager
Phone
(337) 447-4027

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1200 Hospital Dr Ste 4
Opelousas, LA 70570-6552

Mailing address

1119 Prudhomme Cir
Opelousas, LA 70570-6516
Phone (337) 447-4027

Other names 1

  • Acadiana Practitioners' Specialty Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180223000799 LA Part B Supplier - Clinic/Group Practice 4587924188 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Opelousas, LA; Port Barre, LA; Sunset, LA
O20250623002485 LA Part A Provider - Rural Health Clinic 4587924188 Practice locations: Opelousas, LA

Rural health clinic certification: CCN 198933

Legal name
ACADIANA PRACTITIONERS LLC
Doing business as
ACADIANA PRACTITIONERS' SPECIALTY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 27, 2025
Last certification
Aug 27, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
1200 Hospital Dr
Ste 4
Opelousas, LA 70570-6552

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Acadiana Practitioners LLC6 organizations share this tax ID, including this one
Part of
Acadiana Practitioners LLC

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Rhonda Gerace Bergeron Individual 5% Or Greater Direct Ownership InterestPresident Sep 6, 2017 50%
Corporate OfficerPresident Sep 6, 2017 50%
Operational/Managerial ControlPresident Sep 6, 2017 50%
Dustin Joseph Miller Individual 5% Or Greater Direct Ownership InterestPresident Sep 6, 2017 50%
Corporate OfficerPresident Sep 6, 2017 50%
Operational/Managerial ControlPresident Sep 6, 2017 50%

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1738540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738713600000",
    "number": "1649084401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 PRUDHOMME CIR",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705706516",
            "telephone_number": "337-447-4027",
            "fax_number": "337-585-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HOSPITAL DR STE 4",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705706552",
            "telephone_number": "337-948-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIANA PRACTITIONERS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACADIANA PRACTITIONERS LLC",
        "enumeration_date": "2025-02-03",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "337-447-4027"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acadiana Practitioners' Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Acadiana Practitioners' Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Opelousas, LA

Sources for this page

Verify at the official NPI Registry.