Acadiana Pediatrics, L.L.C.
Organization Active NPI Rural Health Clinic/Center · Rayne, LA
NPI 1780191890 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1780191890
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Mark H Dawson, MD
- Title
- Owner
- Phone
- (337) 334-7554
Owners & managing parties with NPI records 2
-
Marin Dawson, DO
-
Mark Dawson, M.D.
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Practitioners 7
-
Marin Dawson, DO
-
Mark Dawson, M.D.
-
Gretchen Cassedy, APRN
-
Katelyn Adair Freyou, APRN-CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
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
- LLC · Proprietary
- Incorporated
- May 24, 2017 in LA
- Enrollment address
- 717 Curtis Drive
Suite a
Rayne, LA 70578-8311
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Lisa Alleman |
W-2 Managing Employee |
May 24, 2017 | |
| Marin R Dawson-Caswell |
5% Or Greater Direct Ownership Interest | May 24, 2017 | 50% |
| Corporate Officer |
May 24, 2017 | ||
| Mark Henry Dawson |
5% Or Greater Direct Ownership Interest | May 24, 2017 | 50% |
| Corporate Officer |
May 24, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180215000029 | LA | Part a Provider - Rural Health Clinic | 7113299066 | Practice locations: Rayne, LA |
National Provider Directory
- Tax ID family
- Acadiana Pediatrics
Locations
717 Curtis Dr
#A
Rayne, LA 70578
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
Other providers in Rayne, LA
- Acadia Chiropractic
- Acadia Parish Police Jury Community Clinic
- Acadia Senior Care, LLC
- Acadiana Family Medical Associates, LLC
- Acadiana Family Practice Lab, Inc.
- Acadiana Pediatrics, L.L.C.
- After the Rain LLC
- Donna Savoy Alleman
- American Legion Hospital
- Arc of Acadiana, Inc
All providers in Rayne, LA · Rural Health Clinic/Center in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.