NPIMap

Organization Active NPI

St Gabriel Health Clinic Inc

Doing business as Gardere Center for Primary Care

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
National Provider Identifier
1962777136
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST GABRIEL HEALTH CLINIC INC
Doing business as
Gardere Center for Primary Care
St Gabriel Health Clinic Inc
Practice address
1707 Gardere LN Ste E
Baton Rouge, LA 70820-8166
Phone
(225) 930-4922
Fax
(225) 930-4926
NPI assigned
Mar 20, 2012
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. GABRIEL HEALTH CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Mrs. Lyssa Morris, MSNNPI 1710649611
Title
Interim Chief Executive Officer
Phone
(225) 642-9676

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1707 Gardere LN Ste E
Baton Rouge, LA 70820-8166

Mailing address

PO Box 209
Saint Gabriel, LA 70776-0209
Phone (225) 642-9676

Other identifiers 1

IdentifierTypeStateIssuer
2191217MedicaidLA

Other names 2

  • Gardere Center for Primary Care Doing business as
  • St Gabriel Health Clinic Inc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150808015705 LA Part A Provider - Federally Qualified Health Center (FQHC) 9830008416 Practice locations: Baton Rouge, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962777136. Details of each certification follow.

Federally qualified health center certification: CCN 191938

Legal name
ST GABRIEL HEALTH CLINIC INC
Doing business as
GARDERE CENTER FOR PRIMARY CARE SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2015
Last certification
Aug 6, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 4, 1993 in LA
Enrollment address
1707 Gardere LN
Ste E
Baton Rouge, LA 70820-8144

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2043370St Gabriel Health Clinic, Inc Gardere Lane1707 Gardere Lane, Baton Rouge, LA 70820Certificate of waiverJul 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
St Gabriel Health Clinic Inc4 organizations share this tax ID, including this one
Part of
St Gabriel Health Clinic Inc

Other organizations with this tax ID 3

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

Locations

1707 Gardere Ln
Ste E
Baton Rouge, LA 70820
Phone (225) 490-4922

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Hazel Schexnayder Individual Corporate DirectorPresident Board Member Mar 1, 1993
Shirley F Wade Individual Corporate Director Mar 1, 2017
Estelle Pullen Individual W-2 Managing Employee Mar 1, 2018
Karen Ambeau-Bess Individual Corporate DirectorBoard Member May 29, 2013

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 7

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": "1332201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1962777136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 209",
            "city": "SAINT GABRIEL",
            "state": "LA",
            "postal_code": "707760209",
            "telephone_number": "225-642-9676",
            "fax_number": "225-642-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 GARDERE LN STE E",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708208166",
            "telephone_number": "225-930-4922",
            "fax_number": "225-930-4926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST GABRIEL HEALTH CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. GABRIEL HEALTH CLINIC, INC",
        "enumeration_date": "2012-03-20",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "LYSSA",
        "authorized_official_title_or_position": "INTERIM CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "225-642-9676",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2191217",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gardere Center for Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Gabriel Health Clinic Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Gabriel Health Clinic Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.