NPIMap

Organization Active NPI

Sabine Medical Associates, Inc

Doing business as Husam Sukerek, MD

  • Rural Health Clinic/Center
  • Many, LA
National Provider Identifier
1790967826
Registry record updated Jun 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SABINE MEDICAL ASSOCIATES, INC
Doing business as
Husam Sukerek, MD
Practice address
210 Highland Dr
Many, LA 71449-3718
Phone
(318) 256-5722
Fax
(318) 256-5774
NPI assigned
Nov 30, 2007
Last updated
Jun 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

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

Authorized official

Name
Husam Sukerek, MDNPI 1699778597
Title
Operations Manager
Phone
(318) 256-5722

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 NU Primary

Addresses

Primary practice location

210 Highland Dr
Many, LA 71449-3718

Mailing address

210 Highland Dr
Many, LA 71449-3718
Phone (318) 256-5722

Other identifiers 1

IdentifierTypeStateIssuer
1034177MedicaidLA

Other names 1

  • Husam Sukerek, MD Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071207000579 LA Part A Provider - Rural Health Clinic 0648369090 Practice locations: Many, LA
O20120420000212 LA Part B Supplier - Clinic/Group Practice 0648369090 Receives reassigned benefits from 1 practitioner
Practice locations: Many, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790967826. Details of each certification follow.

Rural health clinic certification: CCN 193888

Legal name
SABINE MEDICAL ASSOCIATES, INC
Doing business as
SABINE MEDICAL ASSOCIATES, INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 25, 2008
Last certification
Feb 4, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jul 5, 2000 in LA
Enrollment address
210 Highland Dr
Husam H Sukerek MD
Many, LA 71449-3718

National Provider Directory

National Provider Directory
Tax ID family
Sabine Medical Associates I3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

210 Highland Dr
#H
Many, LA 71449
Phone (318) 256-5722

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
Sabine Medical Associates, Inc Organization, Many, LA Created for acquisition, Corporation 5% Or Greater Direct Ownership Interest Mar 1, 2003 25%
5% Or Greater Security Interest Mar 1, 2003
Operational/Managerial Control Mar 1, 2003 100%
Husam H Sukerek Individual 5% Or Greater Direct Ownership Interest Feb 1, 2007 50%
Corporate DirectorOwner, Director, MD Feb 1, 2007 100%
Ikhlas Kanoon Individual 5% Or Greater Direct Ownership Interest Mar 1, 2003 25%
General Partnership InterestOffice Manager Mar 1, 2003 50%
W-2 Managing EmployeeOffice Manager Mar 1, 2003 50%
Operational/Managerial ControlOffice Manager Mar 1, 2003 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1790967826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HIGHLAND DR",
            "city": "MANY",
            "state": "LA",
            "postal_code": "714493718",
            "telephone_number": "318-256-5722",
            "fax_number": "318-256-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 HIGHLAND DR",
            "city": "MANY",
            "state": "LA",
            "postal_code": "714493718",
            "telephone_number": "318-256-5722",
            "fax_number": "318-256-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SABINE MEDICAL ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "SUKEREK",
        "authorized_official_first_name": "HUSAM",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "318-256-5722",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1034177",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Husam Sukerek, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Many, LA

Sources for this page

Verify at the official NPI Registry.