NPIMap

Capitol City Family Health Center, Incorporated

Organization Active NPI Federally Qualified Health Center (FQHC) · Baton Rouge, LA

NPI 1669258448 · NPPES record last updated Oct 31, 2024

Key facts

NPI
1669258448
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Practice address
7777 Hennessy Blvd Ste 608
Baton Rouge, LA 70808-4366
Phone
(225) 767-0394
NPI assigned
Sep 6, 2023
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 8

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 13

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

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 49

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Federally qualified health center certification: CCN 191156

Legal name
CAPITOL CITY FAMILY HEALTH CENTER INCORPORATED
Doing business as
CARESOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 9, 2023
Last certification
Oct 9, 2023
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Dec 8, 1997 in LA
Enrollment address
7777 Hennessy Blvd
Baton Rouge, LA 70808-4300

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 Director
Board Member		 Oct 1, 2019
Edwin Walker
Individual 		Corporate Director
Board Member		 Jun 1, 2018
Ruth Franklin
Individual 		Corporate Director
Secretary		 Mar 1, 2016
Keisha Lacour
Individual 		Corporate Director
Board Member		 Jun 1, 2022
Maimouna Keita
Individual 		Corporate Director
Cfo		 May 1, 2004
W-2 Managing Employee
Cfo		 May 1, 2004
Kenya Nelson
Individual 		W-2 Managing Employee
Billing Manager		 Jan 24, 2000
Richard Andrus
Individual 		Corporate Director
Board Member		 Sep 1, 2014
Kerry Auzenne
Individual 		Corporate Director
Board Member		 Oct 1, 2019
Debra Butler
Individual 		Corporate Director
Treasurer		 Jun 1, 2018
Brian Keith Bernard
Individual 		Corporate Director
Board Member		 Jun 1, 2022
Shirley Lolis
Individual 		Corporate Director
Board Member		 May 1, 2014
Darrin Dixon
Individual 		Corporate Director
Board Member		 Jun 1, 2022
Elaine Patin
Individual 		Corporate Director
Vice President		 Jun 1, 2018
Matthew Valliere
Individual 		Corporate Director
Ceo		 Jan 19, 2016
W-2 Managing Employee
Ceo		 Jan 19, 2016
Edmond Jordan
Individual 		Corporate Director
President		 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 South
Plaquemine, LA · CCN 191943		 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 10, 2014
Caresouth
Zachary, LA · CCN 191981		 Federally qualified health center Other Dec 6, 1997

Medicare enrollment records

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
O20231016000668 LA Part a Provider - Federally Qualified Health Center (FQHC) 5193639151 Practice locations: Baton Rouge, LA

National Provider Directory

Tax ID family
Capitol City Family HLT (14 organizations share this tax ID)

Locations

3111 Florida St
Baton Rouge, LA 70806
Phone (225) 650-2093

Specialties & licenses

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

Addresses

Primary practice location

7777 Hennessy Blvd Ste 608
Baton Rouge, LA 70808-4366

Mailing address

PO Box 66156
Baton Rouge, LA 70896-6156

Other names

  • CareSouth Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 31, 2024.

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1669258448",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD STE 608",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084366",
            "telephone_number": "225-767-0394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-06",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "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",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

All providers in Baton Rouge, LA · Federally Qualified Health Center (FQHC) in Louisiana

Sources for this page

Verify at the official NPI Registry.