NPIMap

Jefferson Community Health Care Centers, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Kenner, LA

NPI 1962997569 · NPPES record last updated Jul 17, 2023

Key facts

NPI
1962997569
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC.
Practice address
2552 Williams Blvd
Kenner, LA 70062-5538
Phone
(504) 437-8523
Fax
(504) 436-3665
NPI assigned
Jun 26, 2018
Organization subpart
No

Authorized official

Name
Joelle M Jessie Skinner
Title
Billing Specialist
Phone
(504) 437-8523

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 6

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 15

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

Practitioners 25

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Federally qualified health center certification: CCN 191001

Legal name
JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC
Doing business as
INCLUSIVCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 15, 2018
Last certification
Aug 15, 2018
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Incorporated
Jan 13, 2004 in LA
Enrollment address
2552 Williams Blvd
Kenner, LA 70062-5538

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Wanda Rose
Individual 		W-2 Managing Employee
Cfo		 Jun 26, 2018 2%
Jeremy G Dumas
Individual 		Corporate Director
Chief Medical Director		 Jan 1, 2018
Shondra G Williams
Individual 		5% Or Greater Indirect Ownership Interest Oct 11, 2013

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20041117000594 LA Part B Supplier - Clinic/Group Practice 7911961115 Receives reassigned benefits from 20 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marrero, LA; Lafitte, LA; Avondale, LA; Kenner, LA
O20180816000266 LA Part a Provider - Federally Qualified Health Center (FQHC) 7911961115 Practice locations: Kenner, LA

National Provider Directory

Tax ID family
Inclusivcare (16 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

2552 Williams Blvd
Kenner, LA 70062-5538

Mailing address

PO Box 2490
Marrero, LA 70073-2490
Phone (504) 371-8958

Other names

  • InclusivCare Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 17, 2023.

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1962997569",
    "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": "504-371-8958",
            "fax_number": "504-328-0899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2552 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700625538",
            "telephone_number": "504-437-8523",
            "fax_number": "504-436-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON COMMUNITY HEALTH CARE CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-26",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "JESSIE SKINNER",
        "authorized_official_first_name": "JOELLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "504-437-8523"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "InclusivCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenner, LA

All providers in Kenner, LA · Federally Qualified Health Center (FQHC) in Louisiana

Sources for this page

Verify at the official NPI Registry.