NPIMap

Individual provider Active NPI

Nichole Michelle Churchman, M.D.

  • Family Medicine Physician
  • Leesville, LA
National Provider Identifier
1700916095
Registry record updated Jul 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD200337 Issued in LA
Practice address
1017 W Fertitta Blvd
Leesville, LA 71446-4646
Phone
(337) 238-4511
Fax
(337) 238-4513
NPI assigned
Mar 6, 2007
Last updated
Jul 15, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD200337 LA Primary

Addresses

Primary practice location

1017 W Fertitta Blvd
Leesville, LA 71446-4646

Mailing address

1017 W Fertitta Blvd
Leesville, LA 71446-4646
Phone (337) 238-4511

Other identifiers 1

IdentifierTypeStateIssuer
1073776MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081119000212 LA Practitioner - Family Practice 7113013640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Group practices
CLHG-LeesvilleGroup PAC ID 4082963301, 25 clinicians
Physical Therapy Services of West Louisiana IncGroup PAC ID 0446388763, 92 clinicians

Practice addresses (Care Compare)

18570 Johnny B Hall Memorial Hwy
Rosepine, LA 70659
Phone (337) 462-1913

301 W Fertitta Blvd
Leesville, LA 71446-4665
Phone (337) 238-9931

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD200337LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CLHG-Leesville Family Medicine CurrentSince May 16, 2020 Accepting new patients
Byrd Medical Clinic Inc Family Medicine CurrentSince Jul 8, 2013 Accepting new patients
CLHG-Leesville CurrentSince May 16, 2020 Accepting new patients
CLHG-Leesville Current Accepting new patients
GPN-Leesville, LLC Past Accepting new patients
Ihc Health Services, Inc. Past Accepting new patients
Rapides Regional Physician Group Specialty Care, LLC PastSince Oct 12, 2019 Accepting new patients
Rapides Regional Physician Group Primary Care, LLC Family Medicine Past Accepting new patients

Locations

427 N Pine St
Deridder, LA 70634
Phone (337) 239-0989

1017 W Fertitta Blvd
Leesville, LA 71446
Phone (337) 239-2606

1020 W Fertitta Blvd
Leesville, LA 71446
Phone (337) 239-5278

506 S 6th St
Leesville, LA 71446
Phone (337) 239-0989

Interoperability endpoints

  • Direct secure messaging: brhngibso@yourcarecommunity.org
  • Direct secure messaging: nichole.churchman.3@17837.direct.athenahealth.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 25

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1700916095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 W FERTITTA BLVD",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464646",
            "telephone_number": "337-238-4511",
            "fax_number": "337-238-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 W FERTITTA BLVD",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464646",
            "telephone_number": "337-238-4511",
            "fax_number": "337-238-4513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCHMAN",
        "first_name": "NICHOLE",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD200337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073776",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesville, LA

Sources for this page

Verify at the official NPI Registry.