NPIMap

Organization Active NPI

Primary Health Services Center

Doing business as PHSC-Grambling Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Grambling, LA
National Provider Identifier
1659827996
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY HEALTH SERVICES CENTER
Doing business as
PHSC-Grambling Family Health Center
Practice address
7604 Hwy 80
Grambling, LA 71245
Phone
(318) 388-1250
NPI assigned
Aug 28, 2016
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
Catherine M. Tonore
Title
Chief Executive Officer
Phone
(318) 388-1250

Specialties & licenses 1

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

Addresses

Primary practice location

7604 Hwy 80
Grambling, LA 71245

Mailing address

7604 Hwy 80
Grambling, LA 71245
Phone (318) 388-1250

Other identifiers 1

IdentifierTypeStateIssuer
2437984MedicaidLA

Other names 1

  • PHSC-Grambling Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170619002637 LA Part A Provider - Federally Qualified Health Center (FQHC) 2062300858 Practice locations: Grambling, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659827996. Details of each certification follow.

Federally qualified health center certification: CCN 191969

Legal name
PRIMARY HEALTH SERVICES CENTER
Doing business as
PHSC- GRAMBLING FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2017
Last certification
Jun 19, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1997 in LA
Enrollment address
7604 Highway 80
Grambling, LA 71245

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
We Care Health Clinic I8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

2915 Betin Ave
Monroe, LA 71201
Phone (318) 651-9945

7604 Highway 80
Ruston, LA 71270

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Pamela Chisley Individual W-2 Managing EmployeeGrants Management Director Dec 1, 2016
Willie Robinson Individual Corporate OfficerBoard Member Dec 1, 2016 0.5%
Primary Health Services Center Organization, Grambling, LA 5% Or Greater Direct Ownership Interest Jun 19, 2017 100%
Cathy Holmes-Giles Individual 5% Or Greater Direct Ownership InterestBoard Member Feb 1, 2017 5%
Sallie M Evans Individual 5% Or Greater Direct Ownership InterestBoard Member Apr 1, 2019 5%
Betty Bullock Individual Corporate OfficerBoard Member Dec 1, 2016 0.5%
Sandra Daigre Individual 5% Or Greater Direct Ownership InterestBoard Member Mar 1, 2016 5%
Shelia Riley Individual 5% Or Greater Direct Ownership InterestBoard Member Apr 1, 2021 5%
Vanessa Johnson Individual Corporate OfficerBoard Member Dec 1, 2016 0.5%
Leon Smith Individual 5% Or Greater Direct Ownership InterestBoard Member Mar 1, 2017 5%
Bertha Williams Individual Corporate OfficerBoard Member Dec 1, 2016 0.5%
Catherine M Tonore Individual 5% Or Greater Direct Ownership InterestCeo Dec 1, 2016 0.5%

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
We Care Health ClinicMonroe, LA, CCN 191838 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2002
Primary Health Services Center- Women Health and Pediatric ClinicMonroe, LA, CCN 191901 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2012
Nov 1, 2012
PHSC West Monroe Family Health CenterWest Monroe, LA, CCN 191013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 28, 2019
Primary Health Services CenterMonroe, LA, CCN 191142 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 21, 2023

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1659827996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7604 HWY 80",
            "city": "GRAMBLING",
            "state": "LA",
            "postal_code": "71245",
            "telephone_number": "318-388-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7604 HWY 80",
            "city": "GRAMBLING",
            "state": "LA",
            "postal_code": "71245",
            "telephone_number": "318-388-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH SERVICES CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "TONORE",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "318-388-1250"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2437984",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHSC-Grambling Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHSC-Grambling Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grambling, LA

Sources for this page

Verify at the official NPI Registry.