NPIMap

Organization Active NPI

Catahoula Parish Hospital District No 2

Doing business as Island Medical

  • Federally Qualified Health Center (FQHC)
  • Sicily Island, LA
National Provider Identifier
1770622631
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CATAHOULA PARISH HOSPITAL DISTRICT NO 2
Doing business as
Island Medical
Practice address
307 Chisum Street
Sicily Island, LA 71368-0008
Phone
(318) 389-5727
Fax
(318) 389-4028
NPI assigned
Feb 6, 2007
Last updated
Apr 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Authorized official

Name
Debra K Miesch, MBA
Title
Ceo
Phone
(318) 389-5727

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X LA Primary

Addresses

Primary practice location

307 Chisum Street
Sicily Island, LA 71368-0008

Mailing address

PO Box 8
307 Chisum Street
Sicily Island, LA 71368-0008
Phone (318) 389-5727

Other identifiers 3

IdentifierTypeStateIssuer
1903191MedicaidLA
1940801MedicaidLA
10464OtherLABLUE CROSS LA

Other names 2

  • ISLAND MEDICAL Doing business as
  • Catahoula Parish Hospital Dist. #2 Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040716000202 LA Part B Supplier - Clinic/Group Practice 8729067434 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
Practice locations: Ferriday, LA; Wisner, LA; Sicily Island, LA; Harrisonburg, LA; Jonesville, LA
O20081117000414 LA Part A Provider - Federally Qualified Health Center (FQHC) 8729067434 Practice locations: Sicily Island, LA
O20101113000178 LA Part A Provider - Federally Qualified Health Center (FQHC) 8729067434 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ferriday, LA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1770622631. Details of each certification follow.

Federally qualified health center certification: CCN 191810

Legal name
CATAHOULA PARISH HOSPITAL DISTRICT NO 2
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
307 Chisum St
Sicily Island, LA 71368-4807

Federally qualified health center certification: CCN 191846

Legal name
CATAHOULA PARISH HOSPITAL DISTRICT NO 2
Doing business as
FERRIDAY FAMILY HEALTH CENTER
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
OtherNon-profit
Incorporated
Feb 10, 2006 in LA
Enrollment address
100 Serio Blvd
Ferriday, LA 71334-2013
Related CCNs
191810

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

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

307 Chisum St
Sicily Island, LA 71368
Phone (318) 389-5727

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
Kathryn Crews Individual Corporate Director Dec 1, 2008
Corporate Director Jul 13, 2010
Clara Valentine Individual Corporate Director Dec 1, 2008
Corporate Director Jul 13, 2010
Debra Miesch Individual 5% Or Greater Direct Ownership InterestCeo Nov 20, 2014 10%
Corporate OfficerCeo Jan 1, 2014
Operational/Managerial ControlCeo Nov 20, 2014 5%
5% Or Greater Direct Ownership InterestCeo Nov 20, 2014 5%
Michelle P Brown Individual W-2 Managing EmployeeBilling Specialist Jan 1, 2015 5%
Marc McCarty Individual Corporate Director Dec 1, 2008
Corporate Director Jul 13, 2010
Trellis Brass Individual Corporate Director Dec 1, 2008
Corporate Director Jul 13, 2010
Jackie Myers Individual Corporate Director Dec 1, 2008
Corporate Director Jul 13, 2010
Eric Price Individual Corporate Director Mar 16, 2011
Sharon Gilmore Individual Corporate Director Jul 13, 2010
Renee Ford Individual W-2 Managing Employee Jul 13, 2010
Catahoula Parish Hospital District No 2 Organization, Sicily Island, LA Operational/Managerial Control Jul 12, 2010

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ferriday Family Health CenterFerriday, LA, CCN 191846 Federally qualified health center Operational/Managerial Control Jul 12, 2010
Jonesville Medical CenterJonesville, LA, CCN 191947 Federally qualified health center 5% Or Greater Direct Ownership Interest (25%) Jan 1, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1770622631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "address_2": "307 CHISUM STREET",
            "city": "SICILY ISLAND",
            "state": "LA",
            "postal_code": "713680008",
            "telephone_number": "318-389-5727",
            "fax_number": "318-389-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 CHISUM STREET",
            "city": "SICILY ISLAND",
            "state": "LA",
            "postal_code": "713680008",
            "telephone_number": "318-389-5727",
            "fax_number": "318-389-4028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATAHOULA PARISH HOSPITAL DISTRICT NO 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "MIESCH",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-389-5727",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1903191",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1940801",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS LA",
            "identifier": "10464",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISLAND MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Catahoula Parish Hospital Dist. #2",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sicily Island, LA

Sources for this page

Verify at the official NPI Registry.