Primary Care Providers for a Healthy Feliciana Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Clinton, LA
NPI 1699878645 · NPPES record last updated Jan 28, 2021
Key facts
- NPI
- 1699878645
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA INC
- Practice address
- 11990 Jackson Street
Clinton, LA 70722-3210 - Phone
- (225) 683-5292
- Fax
- (225) 683-3411
- NPI assigned
- Sep 6, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA INC
Authorized official
- Name
- Ginger A Hunt, FPNP-C
- Title
- Ceo
- Phone
- (225) 683-5292
Other NPIs on the same Medicare enrollment 11
Practitioners 67
-
Myia E Bozeman, FNP
-
Stella E Brown, LCSW, BCSAC
-
Nicole Manno Caraccioli, PMHNP
-
Terrie Normand Ducote, LCSW
-
Angela L Ferrara, LPC
-
Taylor R Goudeau, CNP
-
Angela M Jones, FNP
-
Kristin King Manuel, FNP-C, APRN
-
Ashleye Dunbar McElrath, MA, LPC
-
Althea Palmisano, LSW
-
Taylor Reitz, LCSW
-
Valerie H Smith, LPC
-
Karae M. Stracener, LPC
-
Karra Thomas, FNP-C
-
Daffaney J Webster, PMHNP-BC
-
Monica Williams Weiss, APRN,FNP
-
Clayton Robert Williams, LCSW
-
Natalie Mazhambe Dinecola, MSW, LCSW
-
Marie M Attuso, MD
-
Kelly Bankston, APRN
-
Amanda Barfield, APRN, PMHNP-BC
-
Bettie Blackmon, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D0960606 | RKM Primary Care | Certificate of waiver | May 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in LA
Federally qualified health center certification: CCN 191847
- Legal name
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 10, 2006
- Last certification
- Feb 10, 2006
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 6, 1998 in LA
- Enrollment address
- 11990 Jackson St
Clinton, LA 70722-3210
Federally qualified health center certification: CCN 191940
- Legal name
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
- Doing business as
- RKM PRIMARY CARE SPRINGFIELD
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 14, 2015
- Last certification
- Sep 14, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 6, 1998 in LA
- Enrollment address
- 27124 Highway 42
Springfield, LA 70462-7979
Federally qualified health center certification: CCN 191970
- Legal name
- PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
- Doing business as
- RKM PRIMARY CARE LORANGER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 27, 2017
- Last certification
- Jun 27, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 6, 1998 in LA
- Enrollment address
- 54016 Highway 1062
Loranger, LA 70446-3538
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Richard C Holton |
Corporate Director |
Oct 25, 2007 | |
| Corporate Director | Oct 1, 2007 | ||
| Alfreda D Jackson |
Corporate Director |
Sep 29, 2009 | |
| Veronica D Easterly |
Corporate Director |
Sep 30, 2010 | |
| Corporate Director |
Mar 28, 2013 | ||
| Kenny Sanders |
Corporate Director |
Sep 22, 2011 | |
| Corporate Director | Sep 22, 2011 | ||
| Christi C Hunt |
Corporate Officer |
Oct 17, 2020 | |
| W-2 Managing Employee |
Oct 17, 2020 | ||
| Operational/Managerial Control |
Oct 17, 2020 | ||
| Corporate Officer |
Oct 17, 2021 | ||
| Virdie Moeller |
Corporate Director |
Mar 28, 2013 | |
| Corporate Director | Mar 28, 2013 | ||
| Nicole C Wilcher |
Corporate Director |
Mar 28, 2013 | |
| Corporate Director | Oct 1, 2013 | ||
| Wayne Birt |
Corporate Director |
Aug 31, 2020 | |
| Louis J Kent |
Corporate Director |
Aug 6, 1998 | |
| Corporate Director | Sep 1, 1998 | ||
| Columbus Hutchinson |
Corporate Director |
Mar 29, 2018 | |
| Corporate Director |
Mar 29, 2018 | ||
| Anita P Cambre |
Corporate Director |
Oct 25, 2007 | |
| Corporate Director | Oct 25, 2007 | ||
| Mark Kemp |
Corporate Director |
Mar 28, 2013 | |
| Sheree M Harrell |
Corporate Director |
Aug 31, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040224000173 | LA | Part B Supplier - Clinic/Group Practice | 1052220985 |
Receives reassigned benefits from 99 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Springfield, LA; Slaughter, LA; Port Allen, LA; Jackson, LA; Loranger, LA; Clinton, LA; Baton Rouge, LA; Livingston, LA |
| O20060209000284 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 1052220985 | Practice locations: Clinton, LA |
| O20150904000225 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 1052220985 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Springfield, LA |
| O20170525000701 | LA | Part a Provider - Federally Qualified Health Center (FQHC) | 1052220985 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Loranger, LA |
National Provider Directory
- Part of
- Primary Care Providers for a Healthy Feliciana Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
11990 Jackson Street
Clinton, LA 70722-3210
Mailing address
P.O. Box 395
Clinton, LA 70722-0395
Phone (225) 683-5292
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1450278 | Medicaid | LA |
Other names
- RKM Primary Care
Other providers in Clinton, LA
- Kathleen Parnell
- Shenita L Paynes
- Rikki Hudson Permenter
- Wanda Karen Perry
- Taylor Tynes Priest
- Primary Care Providers for a Healthy Feliciana, Inc
- Primary Care Providers for a Healthy Feliciana, Inc.
- Primary Care Providers for a Healthy Feliciana, Inc.
- Zelma Katherine Randall
- Catrina Ratliff
All providers in Clinton, LA · Federally Qualified Health Center (FQHC) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.