NPIMap

Organization Active NPI

Jefferson Community Health Care Centers Inc

Doing business as Inclusivcare

  • Federally Qualified Health Center (FQHC)
  • Westwego, LA
National Provider Identifier
1942985437
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JEFFERSON COMMUNITY HEALTH CARE CENTERS INC
Doing business as
Inclusivcare
Practice address
435 S Jamie Blvd
Westwego, LA 70094-2860
Phone
(504) 341-4006
NPI assigned
Jun 21, 2023
Last updated
Jun 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Wanda Rose
Title
Cfo
Phone
(504) 206-7738

Specialties & licenses 1

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

Addresses

Primary practice location

435 S Jamie Blvd
Westwego, LA 70094-2860

Mailing address

PO Box 2490
Marrero, LA 70073-2490
Phone (504) 437-8523

Other names 1

  • Inclusivcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230814004060 LA Part A Provider - Federally Qualified Health Center (FQHC) 7911961115 Practice locations: Westwego, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942985437. Details of each certification follow.

Federally qualified health center certification: CCN 191135

Legal name
JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
Doing business as
INCLUSIVCARE-EMMETT GILBERT ELEMENTARY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 11, 2023
Last certification
Aug 11, 2023
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 13, 2004 in LA
Enrollment address
435 S Jamie Blvd
Westwego, LA 70094-2860

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Inclusivcare16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Jeremy G Dumas Individual Corporate DirectorChief Medical Director Jan 1, 2018
Lloyd Clark Individual Other Aug 1, 2023
Audrey Parker Individual Other Aug 1, 2023
Shone Webb Individual Other Aug 1, 2023
Shondra G Williams Individual Corporate OfficerCeo Oct 17, 2013
Operational/Managerial ControlCeo Oct 17, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1687305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1942985437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2490",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700732490",
            "telephone_number": "504-437-8523",
            "fax_number": "504-436-3665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 S JAMIE BLVD",
            "city": "WESTWEGO",
            "state": "LA",
            "postal_code": "700942860",
            "telephone_number": "504-341-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMMUNITY HEALTH CARE CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-21",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "504-206-7738"
    },
    "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": "Inclusivcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westwego, LA

Sources for this page

Verify at the official NPI Registry.