NPIMap

Organization Active NPI

Capitol City Family Health Center, Incorporated

Doing business as CareSouth

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
National Provider Identifier
1669258448
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAPITOL CITY FAMILY HEALTH CENTER, INCORPORATED
Doing business as
CareSouth
Practice address
7777 Hennessy Blvd Ste 608
Baton Rouge, LA 70808-4366
Phone
(225) 767-0394
NPI assigned
Sep 6, 2023
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • CareSouth Doing business as

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669258448. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Dec 8, 1997 in LA
Enrollment address
7777 Hennessy Blvd
Baton Rouge, LA 70808-4300

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Capitol City Family HLT15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

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

904 Catalpa St
Donaldsonville, LA 70346
Phone (225) 264-6800

Ownership & related parties

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 DirectorBoard Member Oct 1, 2019
Edwin Walker Individual Corporate DirectorBoard Member Jun 1, 2018
Ruth Franklin Individual Corporate DirectorSecretary Mar 1, 2016
Keisha Lacour Individual Corporate DirectorBoard Member Jun 1, 2022
Maimouna Keita Individual Corporate DirectorCfo May 1, 2004
W-2 Managing EmployeeCfo May 1, 2004
Kenya Nelson Individual W-2 Managing EmployeeBilling Manager Jan 24, 2000
Richard Andrus Individual Corporate DirectorBoard Member Sep 1, 2014
Kerry Auzenne Individual Corporate DirectorBoard Member Oct 1, 2019
Debra Butler Individual Corporate DirectorTreasurer Jun 1, 2018
Brian Keith Bernard Individual Corporate DirectorBoard Member Jun 1, 2022
Shirley Lolis Individual Corporate DirectorBoard Member May 1, 2014
Darrin Dixon Individual Corporate DirectorBoard Member Jun 1, 2022
Elaine Patin Individual Corporate DirectorVice President Jun 1, 2018
Matthew Valliere Individual Corporate DirectorCeo Jan 19, 2016
W-2 Managing EmployeeCeo Jan 19, 2016
Edmond Jordan Individual Corporate DirectorPresident 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 SouthPlaquemine, LA, CCN 191943 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 10, 2014
CaresouthZachary, LA, CCN 191981 Federally qualified health center Other Dec 6, 1997

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 12

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": "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

Sources for this page

Verify at the official NPI Registry.