NPIMap

Organization Active NPI

Odyssey House Louisiana Inc

  • Federally Qualified Health Center (FQHC)
  • New Orleans, LA
National Provider Identifier
1932578408
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ODYSSEY HOUSE LOUISIANA INC
Practice address
1125 N. Tonti St.
C/O Community Medical Clinic
New Orleans, LA 70119
Phone
(504) 383-8559
NPI assigned
Sep 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Authorized official

Name
Mr. Edward Carlson
Title
Ceo
Phone
(504) 383-8559

Specialties & licenses 1

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

Addresses

Primary practice location

1125 N. Tonti St.
C/O Community Medical Clinic
New Orleans, LA 70119

Mailing address

1125 N Tonti St
C/O Community Clinic
New Orleans, LA 70119-3549
Phone (504) 383-8559

Other names 1

  • Odyssey House Community Medical Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110316000647 LA Part B Supplier - Clinic/Group Practice 5294917928 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: New Orleans, LA
O20160210000234 LA Part A Provider - Federally Qualified Health Center (FQHC) 5294917928 Practice locations: New Orleans, LA

Federally qualified health center certification: CCN 191945

Legal name
ODYSSEY HOUSE LOUISIANA, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 25, 2016
Last certification
Jan 25, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 8, 1983 in LA
Enrollment address
1125 North Tonti St
New Orleans, LA 70119-3549

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Odyssey House Louisiana Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Mia Jefferson Individual Corporate OfficerChief Financial Officer Nov 22, 2007
Darryl Harrison Individual Other Jul 1, 2014
Robert D Matheney Individual Other Oct 1, 2016
Vanessa M Caliste-Swafford Individual Other Dec 1, 2014
Lucinda Lang Individual Other Aug 1, 2017
Derrick Freeman Individual Other Sep 1, 2018
Amy Bosworth Individual Corporate OfficerCoo Jul 1, 2021
Robert Moffett Individual Other Oct 1, 2009
Jarrod Broussard Individual Other Nov 1, 2021
Richard Morgain Individual Other Nov 1, 2021
Curt Bruss Individual Other Jul 1, 2012
Beverly Nichols Individual Other Jul 1, 2012
Odyssey House Louisiana, Inc Organization, New Orleans, LA Corporation, Medical provider/supplier, Non-profit Operational/Managerial Control Mar 1, 2011
Rebecca Miller Individual Other Nov 1, 2021
Angela Strohm Individual Other Nov 1, 2021
Linda Tresemer Individual Other Aug 1, 2020
Edward Carlson Individual Corporate OfficerChief Executive Officer Feb 21, 2001
W-2 Managing EmployeeChief Executive Officer Feb 21, 2001
Cara Hall Individual Other Sep 1, 2015

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Odyssey House Louisiana, IncNew Orleans, LA, CCN 191091 Federally qualified health center Operational/Managerial Control Jan 1, 2018

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1932578408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 N TONTI ST",
            "address_2": "C/O COMMUNITY CLINIC",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701193549",
            "telephone_number": "504-383-8559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 N. TONTI ST.",
            "address_2": "C/O COMMUNITY MEDICAL CLINIC",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "70119",
            "telephone_number": "504-383-8559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODYSSEY HOUSE LOUISIANA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "504-383-8559",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odyssey House Community Medical Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Odyssey House Community Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.