NPIMap

Organization Active NPI

Jefferson Community Health Care Centers, Inc.

Doing business as InclusivCare

  • Federally Qualified Health Center (FQHC)
  • Kenner, LA
National Provider Identifier
1962997569
Registry record updated Jul 17, 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
2552 Williams Blvd
Kenner, LA 70062-5538
Phone
(504) 437-8523
Fax
(504) 436-3665
NPI assigned
Jun 26, 2018
Last updated
Jul 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • InclusivCare Doing business as

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962997569. Details of each certification follow.

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
OtherNon-profit
Incorporated
Jan 13, 2004 in LA
Enrollment address
2552 Williams Blvd
Kenner, LA 70062-5538

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

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 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 EmployeeCfo Jun 26, 2018 2%
Jeremy G Dumas Individual Corporate DirectorChief Medical Director Jan 1, 2018
Shondra G Williams Individual 5% Or Greater Indirect Ownership Interest Oct 11, 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 14

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.

View all 14

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.