NPIMap

Organization Active NPI

David Raines Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Bossier City, LA
National Provider Identifier
1891964789
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DAVID RAINES COMMUNITY HEALTH CENTER, INC
Practice address
1514 Doctors Dr
Bossier City, LA 71111-3379
Phone
(318) 425-2252
Fax
(318) 227-8510
NPI assigned
Feb 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Mr. Willie C White III
Title
Ceo
Phone
(318) 425-2252

Specialties & licenses 1

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

Addresses

Primary practice location

1514 Doctors Dr
Bossier City, LA 71111-3379

Mailing address

3041 Dr Martin Luther King Dr
Shreveport, LA 71107-4705
Phone (318) 227-3350

Other identifiers 2

IdentifierTypeStateIssuer
1706019MedicaidLA
5D174OtherLAMEDICARE PTAN NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041007000508 LA Part B Supplier - Clinic/Group Practice 4688586118 Receives reassigned benefits from 67 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gilliam, LA; Shreveport, LA; Minden, LA; Keithville, LA; Hayneville, LA; Bossier City, LA
O20080317000042 LA Part A Provider - Federally Qualified Health Center (FQHC) 4688586118 Practice locations: Bossier City, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891964789. Details of each certification follow.

Federally qualified health center certification: CCN 191859

Legal name
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Doing business as
DAVID RAINES COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 6, 2008
Last certification
May 6, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 1992 in LA
Enrollment address
1514 Doctors Dr
Bossier City, LA 71111-3379

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory
Tax ID family
David Raines Community Health Center26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1514 Doctors Dr
Bossier City, LA 71111
Phone (318) 549-2500

12763 Lay St
Gilliam, LA 71029
Phone 31822733503170

12201 Mansfield Rd
Keithville, LA 71047
Phone (318) 364-2742

117 South Dr
Natchitoches, LA 71457
Phone (318) 356-7211

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
Darrell Webb Individual Corporate OfficerBoard Jan 1, 2026
Gladys Bush Individual Corporate OfficerTreasurer Jan 1, 2026
Deeandriez Wallace Individual Corporate OfficerBoard Mar 1, 2022
Stephen F Wright Individual Corporate Officer Mar 1, 2022
Fredrick Wilson Individual Corporate OfficerBoard Mar 1, 2022
Kenya Roberts Individual Corporate OfficerBoard Jan 1, 2026
Willie C White Individual Corporate DirectorChief Executive Officer Dec 1, 2003
W-2 Managing EmployeeChief Executive Officer Feb 1, 2008
Todd Hollenshead Individual Corporate DirectorVice President Mar 1, 2022
Myrtis Edwards Individual Corporate Officer Nov 6, 2021
Janice Sneed Individual Corporate OfficerBoard Jan 1, 2026
Ryan Williams Individual Corporate OfficerSecretary Mar 1, 2022

Practitioners & affiliated clinicians

Practitioners 11

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": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1891964789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 DR MARTIN LUTHER KING DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711074705",
            "telephone_number": "318-227-3350",
            "fax_number": "318-222-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 DOCTORS DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113379",
            "telephone_number": "318-425-2252",
            "fax_number": "318-227-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID RAINES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-425-2252",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1706019",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN NUMBER",
            "identifier": "5D174",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.