NPIMap

Organization Active NPI

Excelth, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
National Provider Identifier
1710914049
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
Practice address
730 Colonial Dr Ste E
Baton Rouge, LA 70806-6536
Phone
(225) 201-0751
Fax
(225) 706-0173
NPI assigned
Jun 26, 2006
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
Mr. Michael A. Andry
Title
Ceo
Phone
(504) 524-1210

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Specialist 174400000X NU

Addresses

Primary practice location

730 Colonial Dr Ste E
Baton Rouge, LA 70806-6536

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1441589MedicaidLA
1944581MedicaidLA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161110001346 LA Part A Provider - Federally Qualified Health Center (FQHC) 9830364629 Practice locations: Baton Rouge, LA
O20200529000069 LA Part B Supplier - Clinic/Group Practice 9830364629 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA; New Orleans, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710914049. Details of each certification follow.

Federally qualified health center certification: CCN 191961

Legal name
EXCELTH, INCORPORATED
Doing business as
EXCELTH FAMILY HEALTH CENTER BATON ROUGE OFFICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 9, 2016
Last certification
Nov 9, 2016
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1991 in LA
Enrollment address
730 Colonial Dr
Ste E
Baton Rouge, LA 70806-6536

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

6600 Franklin Ave
Ste A
New Orleans, LA 70122
Phone (504) 620-9868

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
Soledad T Tan Individual Corporate DirectorBoard of Director Feb 1, 2020
Matilda a Tennessee Individual W-2 Managing EmployeeCredentialing Specialist Dec 1, 2014
Michael Andry Individual Corporate OfficerChief Executive Officer Jun 15, 1992
W-2 Managing EmployeeChief Executive Officer Jun 15, 1992
Loyce Pierce Wright Individual Corporate DirectorBoard Member Jan 1, 2021
Shawn T Deggins Individual Corporate Director Sep 15, 2008

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1710914049",
    "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": "730 COLONIAL DR STE E",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708066536",
            "telephone_number": "225-201-0751",
            "fax_number": "225-706-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELTH, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "ANDRY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "504-524-1210",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1441589",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1944581",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.