NPIMap

Organization Active NPI

Excelth, Incorporated

Doing business as EXCELth Family Health Center

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
National Provider Identifier
1699114991
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EXCELTH, INCORPORATED
Doing business as
EXCELth Family Health Center
Practice address
9900 Lake Forest Blvd
Suite F
New Orleans, LA 70127-2609
Phone
(504) 524-1210
Fax
(504) 524-1491
NPI assigned
Jun 19, 2013
Last updated
Jan 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Authorized official

Name
Matilda A Tennessee
Title
Revenue Cycle Manager
Phone
(504) 524-1210

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X
Social Worker 104100000X
Dentist 122300000X
Allergy & Immunology Physician 207K00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Pediatrics Physician 208000000X
Psychiatry Physician 2084P0800X
General Practice Physician 208D00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

9900 Lake Forest Blvd
Suite F
New Orleans, LA 70127-2609

Mailing address

1515 Poydras St
Suite 1070
New Orleans, LA 70112-3723
Phone (504) 524-1210

Other names 1

  • EXCELth Family Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160219000179 LA Part A Provider - Federally Qualified Health Center (FQHC) 9830364629 Practice locations: New Orleans, LA
O20200529000069 LA Part B Supplier - Clinic/Group Practice 9830364629 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
Practice locations: Baton Rouge, LA; New Orleans, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699114991. Details of each certification follow.

Federally qualified health center certification: CCN 191831

Legal name
EXCELTH, INCORPORATED
Doing business as
EXCELTH FAMILY HEALTH CENTER-NEW ORLEANS EAST CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2001
Last certification
Aug 6, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1991 in LA
Enrollment address
9900 Lake Forest Blvd
Ste F
New Orleans, LA 70127-2609

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Excelth Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1111 Newton St
Ste 203
New Orleans, LA 70114

9900 Lake Forest Blvd
New Orleans, LA 70127
Phone (504) 779-5942

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Matilda a Tennessee Individual W-2 Managing EmployeeCredentialing Specialist Dec 1, 2014
Michael Andry Individual Corporate OfficerChief Excecutive Officer Sep 1, 2013
W-2 Managing EmployeeCeo Jun 15, 1992
Shawn T Deggins Individual Corporate Director Sep 15, 2008
Shira Hussain Individual Corporate Director Sep 15, 2010

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1699114991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 POYDRAS ST",
            "address_2": "SUITE 1070",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701123723",
            "telephone_number": "504-524-1210",
            "fax_number": "504-524-1491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 LAKE FOREST BLVD",
            "address_2": "SUITE F",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701272609",
            "telephone_number": "504-524-1210",
            "fax_number": "504-524-1491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELTH, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "TENNESSEE",
        "authorized_official_first_name": "MATILDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "504-524-1210"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EXCELth Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.