NPIMap

Organization Active NPI

West Carroll Health Systems LLC

  • Rural Health Clinic/Center
  • Lake Providence, LA
National Provider Identifier
1851374748
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WEST CARROLL HEALTH SYSTEMS LLC
Doing business as
Lake Providence Medical Clinic
Practice address
319 N Hood St
Lake Providence, LA 71254-2141
Phone
(318) 559-1221
Fax
(318) 559-3321
NPI assigned
Nov 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Authorized official

Name
Dewana Little
Title
Administrator
Phone
(318) 428-3237

Specialties & licenses 1

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

Addresses

Primary practice location

319 N Hood St
Lake Providence, LA 71254-2141

Mailing address

706 Ross St
Oak Grove, LA 71263-9798
Phone (318) 559-1221

Other identifiers 1

IdentifierTypeStateIssuer
1944521MedicaidLA

Other names 1

  • Lake Providence Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624001571 LA Part A Provider - Rural Health Clinic 5294627774 Practice locations: Lake Providence, LA

Rural health clinic certification: CCN 193999

Legal name
WEST CARROLL HEALTH SYSTEMS, LLC
Doing business as
LAKE PROVIDENCE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 3, 1995
Last certification
Oct 20, 2021
Ownership / control type
1B
Most recent change of ownership
Dec 1, 2002 (1 total)
Organization structure
LLCProprietary
Incorporated
Dec 1, 2002 in LA
Enrollment address
203 N Hood Street
Lake Providence, LA 71254-2103
Related CCNs
190081

Other NPIs with the same Medicare PAC ID 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0901787Lake Providence Medical Clinic319 N Hood Street, Lake Providence, LA 71254ComplianceNov 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Carroll Medical Clinic9 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

203 E Miller Ave
Ste B
Iowa, LA 70647
Phone (337) 480-7475

221 N Hood
Lake Providence, LA 71254
Phone (318) 599-1221

319 N Hood St
Lake Providence, LA 71254
Phone (318) 559-1221

712 Settoon St
Oak Grove, LA 71263
Phone (318) 428-2341

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Dewana F Little Individual 5% Or Greater Direct Ownership Interest Dec 1, 2002 10%
Operational/Managerial ControlAdministrator Dec 2, 2002
West Carroll Health Systems, LLC Organization, Oak Grove, LA LLC 5% Or Greater Direct Ownership Interest Dec 1, 2002
Raymond Morris Individual 5% Or Greater Direct Ownership Interest Dec 1, 2002 80%
Amanda D Grey Individual 5% Or Greater Direct Ownership Interest Dec 1, 2002 10%

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West Carroll Memorial HospitalOak Grove, LA, CCN 19Z327 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2002
West Carroll Home HealthOak Grove, LA, CCN 197135 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 1, 2002
Dec 1, 2002
Oak Grove Medical ClinicOak Grove, LA, CCN 193984 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 1, 2002
West Carroll Medical ClinicOak Grove, LA, CCN 193992 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 1, 2002
Community Medical ClinicOak Grove, LA, CCN 193409 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 1, 2002

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1851374748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 ROSS ST",
            "city": "OAK GROVE",
            "state": "LA",
            "postal_code": "712639798",
            "telephone_number": "318-559-1221",
            "fax_number": "318-559-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 N HOOD ST",
            "city": "LAKE PROVIDENCE",
            "state": "LA",
            "postal_code": "712542141",
            "telephone_number": "318-559-1221",
            "fax_number": "318-559-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST CARROLL HEALTH SYSTEMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "DEWANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-428-3237"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1944521",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Providence Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Providence, LA

Sources for this page

Verify at the official NPI Registry.