NPIMap

Organization Active NPI

Natchitoches Parish Hospital Service District

Doing business as NRMC Walk-in Clinic

  • Rural Health Clinic/Center
  • Natchitoches, LA
National Provider Identifier
1902490394
Registry record updated Apr 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT
Doing business as
NRMC Walk-in Clinic
Practice address
740 Keyser Ave Ste E
Natchitoches, LA 71457-6083
Phone
(318) 214-5772
NPI assigned
Feb 25, 2021
Last updated
Apr 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

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

Authorized official

Name
William Bradford McCormick
Title
Cfo
Phone
(318) 214-4350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

740 Keyser Ave Ste E
Natchitoches, LA 71457-6083

Mailing address

501 Keyser Ave
Natchitoches, LA 71457-6018

Other names 1

  • NRMC Walk-in Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210412000945 LA Part A Provider - Rural Health Clinic 2163322140 Practice locations: Natchitoches, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902490394. Details of each certification follow.

Rural health clinic certification: CCN 198534

Legal name
NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT
Doing business as
NRMC WALK-IN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 26, 2021
Last certification
Feb 6, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Oct 1, 1988 in LA
Enrollment address
740 Keyser Ave
Ste E
Natchitoches, LA 71457-6083
Related CCNs
190007

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Milton R Eichmann MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Member organizations 9

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Ronald Corkern Individual Corporate DirectorBoard Member Aug 1, 2021
John Luster Individual Corporate DirectorBoard Member Aug 1, 2021
Michael Newton Individual Corporate DirectorBoard Chair Aug 1, 2021
Brent Probasco Individual Corporate OfficerCfo Jul 5, 2023
W-2 Managing EmployeeCfo Jul 5, 2023
Damian Kirk Soileau Individual Corporate OfficerCeo Apr 1, 2013
Valencia Jones Individual Corporate DirectorBoard Member May 15, 2022
Wayne Halm Individual Corporate DirectorBoard Member Mar 27, 2024
Christopher L Ingram Individual Corporate DirectorBoard Member Aug 1, 2021

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Louisiana Extended Care Hospital of NatchitochesNatchitoches, LA, CCN 192035 Hospital 5% Or Greater Direct Ownership Interest (51%) Feb 24, 2024
Louisiana Extended Care Hospital of NatchitochesNatchitoches, LA, CCN 19TA35 Hospital 5% Or Greater Direct Ownership Interest (51%) Feb 24, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • LLC-I, LLC

    dba Louisiana Extended Care Hospital of Natchitoches

    • Long Term Care Hospital
    • Natchitoches, LA
    • NPI 1083715841

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • LLC-I, LLC

    dba Louisiana Extended Care Hospital of Natchitoches

    • Rehabilitation Hospital Unit
    • Natchitoches, LA
    • NPI 1417609975

    5% Or Greater Direct Ownership Interest

    CMS ownership

Change-of-ownership history 1

DateEventCounterparty
Feb 26, 2021 Change of OwnershipThis provider was the buyer NRMC Walk-in ClinicCCN 193943, LA, NPI 1306233572

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 2

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": "1614211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1902490394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 KEYSER AVE",
            "city": "NATCHITOCHES",
            "state": "LA",
            "postal_code": "714576018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 KEYSER AVE STE E",
            "city": "NATCHITOCHES",
            "state": "LA",
            "postal_code": "714576083",
            "telephone_number": "318-214-5772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-25",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BRADFORD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "318-214-4350"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NRMC Walk-in Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Natchitoches, LA

Sources for this page

Verify at the official NPI Registry.