NPIMap

Organization Active NPI

CLHG-Ruston LLC

Doing business as Allegiance Medical Clinic Northside Family Practice

  • Family Medicine Physician
  • Ruston, LA
National Provider Identifier
1821819665
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLHG-RUSTON LLC
Doing business as
Allegiance Medical Clinic Northside Family Practice
Practice address
1402 Celebrity Dr
Ruston, LA 71270-3878
Phone
(318) 255-1515
Fax
(318) 255-6590
NPI assigned
Oct 23, 2024
Last updated
Oct 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Authorized official

Name
Kathy M Hall
Title
Ceo
Phone
(318) 254-2450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1402 Celebrity Dr
Ruston, LA 71270-3878

Mailing address

1402 Celebrity Dr
Ruston, LA 71270-3878

Other names 1

  • Allegiance Medical Clinic Northside Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220718002173 LA Part B Supplier - Clinic/Group Practice 7315361425 Receives reassigned benefits from 41 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ruston, LA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
CLHG-Ruston LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1402 Celebrity Dr
Ruston, LA 71270
Phone (318) 255-1515

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": "1729641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1821819665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 CELEBRITY DR",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712703878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 CELEBRITY DR",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712703878",
            "telephone_number": "318-255-1515",
            "fax_number": "318-255-6590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLHG-RUSTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-254-2450"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allegiance Medical Clinic Northside Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.