NPIMap

Organization Active NPI

Minden Physician Practices, LLC

Doing business as Minden Primary Care

  • Rural Health Clinic/Center
  • Minden, LA
National Provider Identifier
1699834473
Registry record updated Aug 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MINDEN PHYSICIAN PRACTICES, LLC
Doing business as
Minden Primary Care
Practice address
1111 Homer Rd
Minden, LA 71055-3027
Phone
(318) 377-7500
Fax
(318) 371-3594
NPI assigned
Dec 7, 2006
Last updated
Aug 19, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2020

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

Authorized official

Name
Richard T. Merk
Title
Officer/Authorized Official
Phone
(318) 226-8202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

1111 Homer Rd
Minden, LA 71055-3027

Mailing address

1111 Homer Rd
Minden, LA 71055-3027
Phone (318) 377-7500

Other identifiers 1

IdentifierTypeStateIssuer
1043630MedicaidLA

Other names 1

  • Minden Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090930000103 LA Part B Supplier - Clinic/Group Practice 4789720004 Receives reassigned benefits from 91 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minden, LA; Ringgold, LA; Haughton, LA
O20170722000035 LA Part A Provider - Rural Health Clinic 4789720004 Practice locations: Minden, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699834473. Details of each certification follow.

Rural health clinic certification: CCN 193890

Legal name
MINDEN PHYSICIAN PRACTICES LLC
Doing business as
MINDEN PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 20, 2008
Last certification
Oct 9, 2019
Ownership / control type
1B
Most recent change of ownership
Jul 7, 2017 (2 total)
Organization structure
LLCProprietary
Incorporated
Jul 7, 2017 in LA
Enrollment address
1111 Homer Rd
Minden, LA 71055-3027

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 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2133665Minden Primary Care1111 Homer Road, Minden, LA 71055Provider-performed microscopyJul 23, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Donald Cameron Individual 5% Or Greater Indirect Ownership InterestMember/Officer Aug 1, 2018 16%
Corporate OfficerMember/Officer Aug 1, 2018
Operational/Managerial ControlMember/Officer Aug 1, 2018
Rock Bordelon Individual 5% Or Greater Indirect Ownership InterestMember Aug 1, 2018 80%
Allegiance Health Management Inc Organization, Bossier City, LA Corporation, Management services company, For-profit Operational/Managerial Control Aug 1, 2018
CLHG - Minden, LLC Organization, Minden, LA LLC, For-profit 5% Or Greater Direct Ownership Interest Aug 1, 2018 100%
Cameron Investments LLC Organization, Shreveport, LA LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2018 16%

Owners & managing parties with NPI records 3

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

Facilities with the same owner 54

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

View all 54

Change-of-ownership history 2

DateEventCounterparty
Jul 7, 2017 Change of OwnershipThis provider was the buyer Family Medicine Associates of MindenCCN 193890, LA, NPI 1699834473
Jul 7, 2017 Change of OwnershipThis provider was the seller Minden Primary CareCCN 193890, LA, NPI 1699834473

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1699834473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 HOMER RD",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710553027",
            "telephone_number": "318-377-7500",
            "fax_number": "318-377-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 HOMER RD",
            "city": "MINDEN",
            "state": "LA",
            "postal_code": "710553027",
            "telephone_number": "318-377-7500",
            "fax_number": "318-371-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDEN PHYSICIAN PRACTICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-07",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "MERK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "318-226-8202"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043630",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minden Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minden, LA

Sources for this page

Verify at the official NPI Registry.