NPIMap

Organization Active NPI

Winn Community Health Center, Inc.

Doing business as Mary Goff Elementary School Based Clinic

  • Federally Qualified Health Center (FQHC)
  • Pineville, LA
National Provider Identifier
1871281675
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WINN COMMUNITY HEALTH CENTER, INC.
Doing business as
Mary Goff Elementary School Based Clinic
Practice address
6900 Shreveport Hwy
Pineville, LA 71360-2718
Phone
(318) 648-0375
NPI assigned
Apr 28, 2023
Last updated
Apr 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WINN COMMUNITY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Authorized official

Name
David Adams
Title
Coo
Phone
(318) 648-0375

Specialties & licenses 1

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

Addresses

Primary practice location

6900 Shreveport Hwy
Pineville, LA 71360-2718

Mailing address

PO Box 1288
Winnfield, LA 71483-1288
Phone (318) 209-4501

Other names 1

  • Mary Goff Elementary School Based Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231214001314 LA Part A Provider - Federally Qualified Health Center (FQHC) 2567516545 Practice locations: Pineville, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871281675. Details of each certification follow.

Federally qualified health center certification: CCN 191172

Legal name
WINN COMMUNITY HEALTH CENTER, INC.
Doing business as
MARY GOFF ELEMENTARY SBC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2023
Last certification
Dec 8, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 28, 2023 in LA
Enrollment address
6900 Shreveport Hwy
Pineville, LA 71360-2718

National Provider Directory

National Provider Directory
Tax ID family
Winn Community Health Center65 organizations share this tax ID, including this one
Part of
Winn Community Health Center

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

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
Deano Thornton Individual Corporate Director Mar 1, 2009
W-2 Managing Employee Mar 1, 2009
Operational/Managerial Control Mar 1, 2009
Glenda Melton Individual Corporate Director Feb 1, 2014
Lanika Walker Individual Corporate Director Oct 1, 2021
Brent Hubbard Individual Corporate Director Feb 1, 2014
Cynthia Jamison Individual Corporate Director Jun 1, 2014
Kaye Pyles Individual Corporate Director Aug 20, 2020
Winn Community Health Center, Inc. Organization, Winnfield, LA Non-profit Operational/Managerial Control Mar 1, 2009
Katina Smith Individual Corporate Director Aug 20, 2020
June Melton Individual Corporate Director Sep 1, 2009
Brenda Jones Individual Corporate Director Feb 1, 2013
Joe Bass Individual Corporate Director Mar 1, 2009
Stanley King Individual Corporate Director Nov 1, 2009
Michelle Carpenter Individual Corporate Director Oct 1, 2021
Matthew Walton Individual Corporate Director Feb 1, 2016

All facility ownership & control disclosures 21

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

FacilityTypeRoleSince
Grant Community Health CenterColfax, LA, CCN 191910 Federally qualified health center Operational/Managerial Control Feb 24, 2014
Bienville Community Health CenterRinggold, LA, CCN 191941 Federally qualified health center Operational/Managerial Control Sep 1, 2015
Winn Community Health Center, Inc.Ruston, LA, CCN 191975 Federally qualified health center Operational/Managerial Control Apr 1, 2017
Winn Community Health Center, Inc.Pollock, LA, CCN 191979 Federally qualified health center Operational/Managerial Control Jul 17, 2017
Rapides Academy School Based ClinicAlexandria, LA, CCN 191080 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Cherokee Elementary School Based ClinicAlexandria, LA, CCN 191079 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Tioga Elementary School Based ClinicBall, LA, CCN 191078 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Hayden R Lawrence Upper EsbcDeville, LA, CCN 191085 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Oak Hill High School Based ClinicElmer, LA, CCN 191099 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Forest Hill Jr High School Based ClinicForest Hill, LA, CCN 191106 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Poland Jr. High School Based ClinicAlexandria, LA, CCN 191105 Federally qualified health center Operational/Managerial Control May 25, 2022
Plainview High School Based ClinicGlenmora, LA, CCN 191103 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Ball Elementary School Based ClinicBall, LA, CCN 191102 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Rapides High School Based ClinicLecompte, LA, CCN 191114 Federally qualified health center Operational/Managerial Control Mar 1, 2019
Carter C. Raymond Elementary School Based ClinicLecompte, LA, CCN 191113 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Alma Redwine EsbcAlexandria, LA, CCN 191164 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Paradise EsbcBall, LA, CCN 191171 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Ruby Wise Elementary SBCPineville, LA, CCN 191174 Federally qualified health center Operational/Managerial Control Mar 1, 2009
South Grant Community Health CenterDry Prong, LA, CCN 191186 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Winnfield Physical TherapyWinnfield, LA, CCN 191199 Federally qualified health center Operational/Managerial Control Mar 1, 2009
Montgomery Community Health CenterMontgomery, LA, CCN 951198 Federally qualified health center Operational/Managerial Control Mar 1, 2009

Facilities with the same owner 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1682640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1871281675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1288",
            "city": "WINNFIELD",
            "state": "LA",
            "postal_code": "714831288",
            "telephone_number": "318-209-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 SHREVEPORT HWY",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713602718",
            "telephone_number": "318-648-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINN COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINN COMMUNITY HEALTH CENTER, INC.",
        "enumeration_date": "2023-04-28",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "318-648-0375"
    },
    "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": "Mary Goff Elementary School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pineville, LA

Sources for this page

Verify at the official NPI Registry.