NPIMap

Organization Active NPI

Acadiana Pediatrics, L.L.C.

  • Rural Health Clinic/Center
  • Rayne, LA
National Provider Identifier
1780191890
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACADIANA PEDIATRICS, L.L.C.
Practice address
717 Curtis Dr
Rayne, LA 70578-8311
Phone
(337) 334-7551
Fax
(337) 334-7556
NPI assigned
Jan 10, 2018
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mark H Dawson, MDNPI 1043210271
Title
Owner
Phone
(337) 334-7554

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

717 Curtis Dr
Rayne, LA 70578-8311

Mailing address

717 Curtis Dr Ste a
Rayne, LA 70578-8311
Phone (337) 334-7554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180215000029 LA Part A Provider - Rural Health Clinic 7113299066 Practice locations: Rayne, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780191890. Details of each certification follow.

Rural health clinic certification: CCN 193940

Legal name
ACADIANA PEDIATRICS, L.L.C.
Doing business as
ACADIANA PEDIATRICS & FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 10, 2018
Last certification
Aug 10, 2024
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
May 24, 2017 in LA
Enrollment address
717 Curtis Drive
Suite a
Rayne, LA 70578-8311

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Acadiana Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

717 Curtis Dr
#A
Rayne, LA 70578

717 Curtis Dr
Ste A
Rayne, LA 70578
Phone (337) 334-7554

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Lisa Alleman Individual W-2 Managing EmployeeClinic Manager May 24, 2017
Marin R Dawson-Caswell Individual 5% Or Greater Direct Ownership Interest May 24, 2017 50%
Corporate OfficerOfficer May 24, 2017
Mark Henry Dawson Individual 5% Or Greater Direct Ownership Interest May 24, 2017 50%
Corporate OfficerOfficer May 24, 2017

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780191890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 CURTIS DR STE A",
            "city": "RAYNE",
            "state": "LA",
            "postal_code": "705788311",
            "telephone_number": "337-334-7554",
            "fax_number": "337-334-7556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 CURTIS DR",
            "city": "RAYNE",
            "state": "LA",
            "postal_code": "705788311",
            "telephone_number": "337-334-7551",
            "fax_number": "337-334-7556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADIANA PEDIATRICS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-334-7554",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rayne, LA

Sources for this page

Verify at the official NPI Registry.