NPIMap

Organization Active NPI

Iberia Comprehensive Community Health Center,Inc.

Doing business as Merryville Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Merryville, LA
National Provider Identifier
1891020012
Registry record updated Dec 1, 2021
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.
Doing business as
Merryville Community Health Center
Practice address
567 Walker Street
Merryville, LA 70653
Phone
(337) 365-4945
Fax
(337) 367-3917
NPI assigned
Oct 6, 2009
Last updated
Dec 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Authorized official

Name
Mrs. Nicole Roberson, MBA
Title
Health Information Manager
Phone
(337) 365-4945

Specialties & licenses 1

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

Addresses

Primary practice location

567 Walker Street
Merryville, LA 70653

Mailing address

567 Walker Street
Merryville, LA 70653
Phone (337) 365-4945

Other identifiers 1

IdentifierTypeStateIssuer
1803570MedicaidLA

Other names 1

  • MERRYVILLE COMMUNITY 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
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
O20101007001223 LA Part A Provider - Federally Qualified Health Center (FQHC) 6204817828 Practice locations: Merryville, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891020012. Details of each certification follow.

Federally qualified health center certification: CCN 191876

Legal name
IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER,INC.
Doing business as
MERRYVILLE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 7, 2010
Last certification
Oct 7, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 29, 1985 in LA
Enrollment address
567 Walker St
Merryville, LA 70653-3040

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.

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
19D1106342Merryville Community Health Center567 Walker Street, Merryville, LA 70653Provider-performed microscopyOct 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Martin Parish CHC Pharmacy15 organizations share this tax ID, including this one
Part of
St Martin Parish CHC Pharmacy

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Gloria Obrien Individual Corporate DirectorBoard Member Oct 1, 2009
Joann Nixon Individual Corporate DirectorBoard Member Oct 1, 2009
Paula Smith Individual Corporate DirectorBoard Member Feb 28, 2012
Sharon Ann Williams Individual Corporate DirectorBoard Member Oct 1, 2009
Bradley Fulgence Individual Corporate DirectorBoard Member Oct 1, 2009
Ernestine Burton Epperson Individual Corporate DirectorBoard Member Oct 1, 2009
Sandra Moore Individual Corporate DirectorBoard Member Oct 1, 2009
Debra K Milson Individual Corporate DirectorBoard Member Jan 24, 2012
Megan Reed Individual W-2 Managing EmployeeBilling Manager Apr 1, 2025 100%
Operational/Managerial ControlBilling Manager Apr 1, 2025 100%
Margaret Green Individual Corporate DirectorBoard Member Oct 1, 2009
Maxia Hutchinson Individual Corporate DirectorBoard Member Oct 1, 2009
Roderick C Campbell Individual Corporate DirectorCeo Feb 26, 2002 100%
W-2 Managing EmployeeCeo Oct 1, 2009 100%

Owners & managing parties with NPI records 1

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

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 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": "1254787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638316800000",
    "number": "1891020012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 WALKER STREET",
            "city": "MERRYVILLE",
            "state": "LA",
            "postal_code": "70653",
            "telephone_number": "337-365-4945",
            "fax_number": "337-367-3917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 WALKER STREET",
            "city": "MERRYVILLE",
            "state": "LA",
            "postal_code": "70653",
            "telephone_number": "337-365-4945",
            "fax_number": "337-367-3917"
        }
    ],
    "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": "2009-10-06",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "HEALTH INFORMATION MANAGER",
        "authorized_official_telephone_number": "337-365-4945",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1803570",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERRYVILLE COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merryville, LA

Sources for this page

Verify at the official NPI Registry.