NPIMap

Organization Active NPI

Christus Health Central Louisiana

Doing business as CHRISTUS Coushatta Rural Health Center

  • Critical Access Hospital Clinic/Center
  • Coushatta, LA
National Provider Identifier
1871584722
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X
License
551RHC-1 Issued in LA
Legal business name
CHRISTUS HEALTH CENTRAL LOUISIANA
Doing business as
CHRISTUS Coushatta Rural Health Center
Practice address
1633 Marvel Street
Coushatta, LA 71019-9022
Phone
(318) 932-2081
Fax
(318) 932-2215
NPI assigned
Oct 31, 2005
Last updated
Oct 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Authorized official

Name
Monte Wilson
Title
Ceo
Phone
(337) 470-2100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 551RHC-1 LA Primary
Rural Health Clinic/Center 261QR1300X NU

Addresses

Primary practice location

1633 Marvel Street
Coushatta, LA 71019-9022

Mailing address

PO Box 847329
Dallas, TX 75284-7329
Phone (800) 756-7999

Other identifiers 1

IdentifierTypeStateIssuer
1443913MedicaidLA

Other names 1

  • CHRISTUS Coushatta Rural Health 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
O20041217000320 LA Part A Provider - Rural Health Clinic 4688570955 Practice locations: Coushatta, LA
O20050427000891 LA Part B Supplier - Clinic/Group Practice 4688570955 Receives reassigned benefits from 14 practitioners
Practice locations: Coushatta, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871584722. Details of each certification follow.

Rural health clinic certification: CCN 193445

Legal name
CHRISTUS HEALTH CENTRAL LOUISIANA
Doing business as
CHRISTUS COUSHATTA RURAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 2, 2002
Last certification
Sep 22, 2021
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2005 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Nov 19, 1946 in LA
Enrollment address
1633 Marvel St
Coushatta, LA 71019-9022
Related CCNs
191312

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

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
19D0999445Christus Coushatta Rural Health Center1633 Marvel Street, Coushatta, LA 71019Certificate of waiverFeb 21, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jason Miller Individual Corporate OfficerCfo Aug 28, 2023
Christus Health Organization, Irving, TX Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2005 100%
Ernie Sadau Individual Corporate Director Mar 1, 2011
Aloysia C Ducote Individual Corporate Director Jan 1, 2014
Sonia Acosta Individual Corporate DirectorCorporate Secretary Sep 16, 2024
Monte Wilson Individual Corporate OfficerCeo May 12, 2021
W-2 Managing EmployeeCeo May 12, 2021
Fadi V Nasrallah Individual Corporate DirectorBoard Member Feb 22, 2024

Facilities with the same owner 47

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

View all 47

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1871584722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847329",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847329",
            "telephone_number": "800-756-7999",
            "fax_number": "469-282-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 MARVEL STREET",
            "city": "COUSHATTA",
            "state": "LA",
            "postal_code": "710199022",
            "telephone_number": "318-932-2081",
            "fax_number": "318-932-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTUS HEALTH CENTRAL LOUISIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MONTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-470-2100"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "LA",
            "license": "551RHC-1",
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1443913",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTUS Coushatta Rural Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHRISTUS Coushatta Rural Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coushatta, LA

Sources for this page

Verify at the official NPI Registry.