NPIMap

Organization Active NPI

Iberia Comprehensive Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • New Iberia, LA
National Provider Identifier
1831877653
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.
Practice address
1110 Angers St
New Iberia, LA 70563-2012
Phone
(337) 364-0425
NPI assigned
Jul 11, 2023
Organization subpart
Yes
Parent organization
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Authorized official

Name
Darnell Ann Boudreaux
Title
Director of Health Information
Phone
(337) 365-4945

Specialties & licenses 1

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

Addresses

Primary practice location

1110 Angers St
New Iberia, LA 70563-2012

Mailing address

806 Jefferson Ter
New Iberia, LA 70560-5727
Phone (337) 365-4945

Other names 1

  • Iberia Comprehensive Vision Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050809000029 LA Part B Supplier - Clinic/Group Practice 6204817828 Receives reassigned benefits from 43 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Leesville, LA; Saint Martinville, LA; New Iberia, LA; Merryville, LA; Many, LA; Lafayette, LA; Deridder, LA; Abbeville, LA
O20231016000663 LA Part A Provider - Federally Qualified Health Center (FQHC) 6204817828 Practice locations: New Iberia, LA

Federally qualified health center certification: CCN 191158

Legal name
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER,INC.
Doing business as
IBERIA COMPREHENSIVE VISION CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 13, 2023
Last certification
Oct 13, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 26, 1985 in LA
Enrollment address
1110 Angers St
New Iberia, LA 70563-2012

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Iberia Comprehensive Co15 organizations share this tax ID, including this one
Part of
Iberia Comprehensive Co

Other organizations with this tax ID 14

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

View all 14

Locations

19850 Old Scenic Hwy
Ste 500
Zachary, LA 70791
Phone (225) 658-8283

4315 Church St
#B
Zachary, LA 70791
Phone (225) 658-8283

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
David Jones Individual Corporate Officer Sep 1, 2023
Joann Nixon Individual Corporate Officer Sep 1, 2023
Richard Williams Individual Corporate Officer Sep 1, 2023
Sharon Ann Williams Individual Corporate Officer Sep 1, 2023
Bradley Fulgence Individual Corporate Officer Sep 1, 2023
Bronel Hebert Individual Corporate Officer Sep 1, 2023
Sandra Moore Individual Corporate Officer Sep 1, 2023
Nathaniel Mitchell Individual Corporate Officer Sep 1, 2023
Lisa Nelson Individual Corporate Officer Sep 1, 2023
Bayphone Foreman Individual Corporate Officer Sep 1, 2023
Margaret Green Individual Corporate Officer Sep 1, 2023
Roderick C Campbell Individual Corporate Director Sep 25, 2023
W-2 Managing Employee Sep 25, 2023
Sandra M Reinhardt Individual Corporate Officer Sep 1, 2023
Caleb a Henry Individual Corporate Officer Sep 1, 2023

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1831877653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 JEFFERSON TER",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705605727",
            "telephone_number": "337-365-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 ANGERS ST",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705632012",
            "telephone_number": "337-364-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "DARNELL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH INFORMATION",
        "authorized_official_telephone_number": "337-365-4945"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iberia Comprehensive Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Iberia, LA

Sources for this page

Verify at the official NPI Registry.