NPIMap

Organization Active NPI

Hospital Service District No 2 of Parish of Beauregard State of la

  • Rural Health Clinic/Center
  • Deridder, LA
National Provider Identifier
1912372897
Registry record updated Apr 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
Practice address
301 S Washington St
Suite B
Deridder, LA 70634-4861
Phone
(337) 460-7688
Fax
(337) 460-7691
NPI assigned
Dec 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2016

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

Authorized official

Name
Robert Charron
Title
Ceo
Phone
(337) 462-7100

Specialties & licenses 1

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

Addresses

Primary practice location

301 S Washington St
Suite B
Deridder, LA 70634-4861

Mailing address

600 S Pine St
Deridder, LA 70634-4942

Other names 1

  • Beauregard Medical and Surgical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160425001988 LA Part A Provider - Rural Health Clinic 6800958083 Practice locations: Deridder, LA

Rural health clinic certification: CCN 198501

Legal name
HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA
Doing business as
BEAUREGARD MEDICAL AND SURGICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 20, 2017
Last certification
Dec 20, 2023
Ownership / control type
Non-profit – church related
Organization structure
CorporationProprietary
Incorporated
Apr 18, 1989 in LA
Enrollment address
301 S Washington St
Deridder, LA 70634-4861
Related CCNs
190050

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Hospital Service District No 2 of Parish of Beauregard State of la6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member organizations 6

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

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
Tommie Cole Individual Corporate DirectorBoard Member Apr 19, 2013
Martha Banks Individual Corporate DirectorBoard Member Sep 13, 2011
Lana Richelle Bowman Individual Corporate DirectorBoard Member Aug 14, 2018
Traci Thibodeaux Individual Corporate OfficerCeo Jan 1, 2021
W-2 Managing EmployeeCeo Jan 1, 2021
Berl Andrews Individual Corporate DirectorBoard Member May 9, 2017
Connie Westfall Individual Corporate DirectorBoard Member Aug 11, 2020
Heather N Nortman Individual Corporate DirectorBoard Member May 17, 2013
Hospital Service District No 2 of Parish of Beauregard State of la Organization, Deridder, LA Corporation 5% Or Greater Direct Ownership Interest Apr 18, 1989 100%
Operational/Managerial Control Apr 1, 2014 100%
Joan Lester Individual Corporate DirectorBoard Member Feb 10, 2015
Samuel Miller Individual Corporate DirectorBoard Member Jul 13, 2012
Kenneth Farmer Individual Corporate DirectorBoard Member Sep 1, 2015
Jarred Veillon Individual Corporate Officer Dec 6, 2021

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Beauregard Memorial HospitalDeridder, LA, CCN 190050 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 25, 1978
Beauregard Memorial HospitalDeridder, LA, CCN 19U050 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 25, 1978
Beauregard Home HealthDeridder, LA, CCN 197183 Home health agency 5% Or Greater Direct Ownership Interest (33%) Oct 1, 2008
Beauregard Internal Medicine CenterDeridder, LA, CCN 193498 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 25, 1978
Apr 1, 2014
Beauregard Women'S Health CenterDeridder, LA, CCN 193499 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 18, 1989
Apr 1, 2014

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

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

NPI Registry JSON

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

{
    "created_epoch": "1449100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461628800000",
    "number": "1912372897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S PINE ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S WASHINGTON ST",
            "address_2": "SUITE B",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344861",
            "telephone_number": "337-460-7688",
            "fax_number": "337-460-7691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL SERVICE DISTRICT NO 2 OF PARISH OF BEAUREGARD STATE OF LA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-03",
        "last_updated": "2016-04-26",
        "status": "A",
        "authorized_official_last_name": "CHARRON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-462-7100"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beauregard Medical and Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deridder, LA

Sources for this page

Verify at the official NPI Registry.