NPIMap

Organization Active NPI

St. James Parish Hosp Serv Dist

Doing business as Poche' Medical Clinic

  • Family Medicine Physician
  • Lutcher, LA
National Provider Identifier
1649617689
Registry record updated May 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST. JAMES PARISH HOSP SERV DIST
Doing business as
Poche' Medical Clinic
Practice address
1645 Lutcher Ave
Lutcher, LA 70071-5150
Phone
(225) 869-3493
Fax
(225) 869-9333
NPI assigned
May 31, 2013
Last updated
May 8, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2017

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

Authorized official

Name
Mary Ellen G Pratt
Title
Ceo
Phone
(225) 258-5990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1645 Lutcher Ave
Lutcher, LA 70071-5150

Mailing address

1645 Lutcher Ave
Lutcher, LA 70071-5150
Phone (225) 258-5906

Other names 1

  • Poche' Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130827000322 LA Part B Supplier - Clinic/Group Practice 3476459850 Receives reassigned benefits from 5 practitioners
Practice locations: Lutcher, LA

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
East Bank Family Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
St. James Parish HospitalLutcher, LA, CCN 191305 Hospital Operational/Managerial Control Apr 15, 2008
St. James Parish Hosp Serv DistLutcher, LA, CCN 19Z305 Hospital Operational/Managerial Control Apr 15, 2008

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 8

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": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494201600000",
    "number": "1649617689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 LUTCHER AVE",
            "city": "LUTCHER",
            "state": "LA",
            "postal_code": "700715150",
            "telephone_number": "225-258-5906",
            "fax_number": "225-869-5271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 LUTCHER AVE",
            "city": "LUTCHER",
            "state": "LA",
            "postal_code": "700715150",
            "telephone_number": "225-869-3493",
            "fax_number": "225-869-9333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JAMES PARISH HOSP SERV DIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2017-05-08",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "MARY ELLEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "225-258-5990"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poche' Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lutcher, LA

Sources for this page

Verify at the official NPI Registry.