NPIMap

Organization Active NPI

Access Health Louisiana

Doing business as South Broad Community Health

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
National Provider Identifier
1891199766
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ACCESS HEALTH LOUISIANA
Doing business as
South Broad Community Health
Practice address
3300 S. Broad St.
New Orleans, LA 70125-2942
Phone
(504) 309-5061
Fax
(504) 575-3691
NPI assigned
Oct 21, 2014
Last updated
Sep 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Authorized official

Name
Mark Keiser
Title
President
Phone
(504) 575-3700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TF0000X DO.000157 LA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MD.023712 LA
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3300 S. Broad St.
New Orleans, LA 70125-2942

Mailing address

2900 Indiana Ave
Kenner, LA 70065-4605
Phone (504) 575-3712

Other names 1

  • South Broad Community Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150605000644 LA Part A Provider - Federally Qualified Health Center (FQHC) 3678484276 Practice locations: New Orleans, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891199766. Details of each certification follow.

Federally qualified health center certification: CCN 191939

Legal name
ACCESS HEALTH LOUISIANA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2015
Last certification
Jun 4, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 15, 2002 in LA
Enrollment address
3300 South Broad Street
New Orleans, LA 70119-2942

National Provider Directory

National Provider Directory
Tax ID family
St Charles Community Health Center Inc89 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Peter Torsch Individual Corporate Director Nov 20, 2015
Germaine L Robottom Individual Corporate Officer Apr 23, 2016
Estelle Alfortish Individual Corporate Officer Apr 23, 2018
Gaynell Alexander-Coleman Individual Corporate Officer Mar 1, 2003
Brooks Trotter Individual Corporate Officer Feb 24, 2011
Scott Falgoust Individual Corporate Officer May 31, 2018
Mark Francis Keiser Individual Corporate Director Mar 1, 2003
W-2 Managing Employee Mar 1, 2003
Sandra Zimmer Individual Corporate Officer Oct 25, 2018
John Cressend Schonberg Individual Corporate Officer Apr 23, 2009
Timothy J. Vial Individual Corporate Director Apr 23, 2010
Wendy Benedeto Individual Corporate Officer Apr 23, 2022

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
St James Alternative School SBHCVacherie, LA, CCN 191087 Federally qualified health center Operational/Managerial Control Apr 1, 2003
Kenner Community Health CenterKenner, LA, CCN 191096 Federally qualified health center Operational/Managerial Control Apr 1, 2003
Luling Elementary School SBHCLuling, LA, CCN 191100 Federally qualified health center Operational/Managerial Control Apr 1, 2003
Destrehan HS SBHCDestrehan, LA, CCN 191104 Federally qualified health center Operational/Managerial Control Apr 1, 2003

NPI Registry JSON

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

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1891199766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 INDIANA AVE",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700654605",
            "telephone_number": "504-575-3712",
            "fax_number": "504-575-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 S. BROAD ST.",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701252942",
            "telephone_number": "504-309-5061",
            "fax_number": "504-575-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS HEALTH LOUISIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "KEISER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "504-575-3700"
    },
    "taxonomies": [
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": "LA",
            "license": "DO.000157",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.023712",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Broad Community Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.