NPIMap

Organization Active NPI

Blanchard Medical

  • Rural Health Clinic/Center
  • Shreveport, LA
National Provider Identifier
1760089791
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BLANCHARD MEDICAL
Doing business as
Blanchard Medical
Practice address
5948 N Market St
Shreveport, LA 71107-2017
Phone
(318) 375-0001
Fax
(318) 375-0002
NPI assigned
Oct 2, 2020
Last updated
Jan 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH CADDO HOSPITAL SERVICE DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Authorized official

Name
Mr. Dakota Robinson
Title
Cfo
Phone
(318) 375-4097

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

5948 N Market St
Shreveport, LA 71107-2017

Mailing address

5948 N Market St
Shreveport, LA 71107-2017
Phone (318) 375-0001

Other identifiers 1

IdentifierTypeStateIssuer
2570587MedicaidLA

Other names 1

  • Blanchard Medical Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201216001046 LA Part B Supplier - Clinic/Group Practice 8325450315 Receives reassigned benefits from 16 practitioners
Practice locations: Shreveport, LA
O20210405001704 LA Part A Provider - Rural Health Clinic 8325450315 Practice locations: Shreveport, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760089791. Details of each certification follow.

Rural health clinic certification: CCN 198536

Legal name
BLANCHARD MEDICAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 3, 2021
Last certification
Aug 3, 2021
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Jan 31, 2021 in LA
Enrollment address
5948 N Market St
Shreveport, LA 71107-2017
Related CCNs
191304

Facilities connected through Provider of Services related, parent or unit certification numbers.

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
19D2211996Blanchard Medical5948 North Market, Shreveport, LA 71107ComplianceJan 12, 2028

National Provider Directory

National Provider Directory
Part of
Charles L Metzger MD

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Dakota Robinson Individual Operational/Managerial ControlCfo Oct 28, 2018
Thomas Tebbe Individual Corporate Officer Feb 1, 2024
Robert Green Individual Corporate OfficerBoard Member Sep 25, 1991
North Caddo Hospital Service District Organization, Vivian, LA Other Jan 1, 2021 100%
Michael Nation Individual Corporate Officer Aug 5, 2021
Jennifer Fant Individual Corporate Officer Jun 7, 2022
David Jones Individual Corporate DirectorCeo Aug 1, 2005
Operational/Managerial ControlCeo Aug 1, 2005
Brenda Smith Individual Corporate Officer Sep 6, 2001
Kenneth Cochran Individual Corporate OfficerBoard Member Jul 19, 2018
David Norman Individual Corporate Officer Aug 20, 2009
Mary Irvin Individual Corporate Officer Sep 6, 2001

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1760089791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5948 N MARKET ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711072017",
            "telephone_number": "318-375-0001",
            "fax_number": "318-375-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5948 N MARKET ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711072017",
            "telephone_number": "318-375-0001",
            "fax_number": "318-375-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLANCHARD MEDICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH CADDO HOSPITAL SERVICE DISTRICT",
        "enumeration_date": "2020-10-02",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "DAKOTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "318-375-4097",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2570587",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blanchard Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blanchard Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.