november 2009 - louisiananew.dhh.louisiana.gov/assets/docs/making_medicaid_better/... · november...

November 2009

CommunityCARE Primary Care Physicians for Louisiana

Printed:

Data as of:

11/5/2009

11/5/2009

88 8 18

9 4 9 6

5

5

5

16

9 6

4

50

17

5

4 8

6 10

16 65

18

8

6 7

2

6

9

67

2

9

8 19 44

21

25

73 11

44

11

4 7

148

33 19

19

5

9 15

16

17

46

216 119

57

6

7

7

24

52 23

62 2

3

ACS Government Healthcare Solutions

REGION

PARISH CITY PROVIDER NAME ADDRESS RESTRICTIONSPOT.

CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE

* K - Does all age groups S - Subcontracting all age groups B - Both1

CommunityCARE Provider Count by Parish

JEFFERSON-EAST BANK

KENNER SAMUEL BROWN MD - AMC PHY PEDIATRICS K 2 4 4515 4500 AGES 0 - 203813 WILLIAMS BOULEVARD,

KENNER - 70065

(504)443-5437

1442437-001

BROWN, SAMUEL, MD - 1136689

CLARK, PATRICIA, NP - 1173762

DELASH, CAROL, NP - 1651591

HARRIS, JENNIFER, NP - 1624101

MCDONALD, JAMIE, NP - 1016691

TOLMAS, HYMAN, MD - 1670944

KENNER AFZAL FIAZ PHY INTERNAL MEDICINE K 1 0 733 2500 AGES 0 - 641000 VETERANS BOULEVARD,

KENNER - 70062

(504)891-9800

1687553-001

KENNER ARA ANJUMAN PHY INTERNAL MEDICINE 1 0 133 2500 AGES 21 - 64200 WEST ESPLANADE AVENUE,

SUITE 312, KENNER - 70065

(504)712-8872

1184136-001

KENNER CERRATO CIRO PHY INTERNAL MEDICINE /

CARDIOVASCULAR

1 0 216 2500 AGES 21 - 643814 WILLIAMS BOULEVARD,

KENNER - 70065

(504)465-0115

1148741-001

KENNER CHILDREN'S HOSPITAL MEDICAL

PRACTICE CORP (site 014)

PHY PEDIATRICS K 4 0 474 2500 AGES 0 - 203321 FLORIDA AVENUE, KENNER

- 70065

(504)468-4437

1946711-014

KHOURI, ANAS, MD - 1683574

LEFEVRE, SUZANNE, MD - 1491756

LINARES, EDITH, MD - 1373303

PASTERNAK, RYAN, MD - 1576328

Page 1 of 233


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CAP.

CURRENT

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NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



KENNER ESTARIS RAUL PHY INTERNAL MEDICINE /

FAMILY PRACTICE

1 0 254 2500 AGES 21 - 643321 FLORIDA AVENUE, KENNER

- 70065

(504)465-0800

1372064-001

KENNER GAUTREAUX, III JOSEPH PHY GENERAL PRACTICE S 1 0 40 2500 AGES 4 - 64200 WEST ESPLANADE AVENUE,


(504)464-8683

1307505-001

KENNER GELMAN VADIM PHY OBGYN 1 0 89 2500 FEMALES ONLY, AGES 21

- 40200 WEST ESPLANADE AVENUE,


(504)464-8750

1697214-001

KENNER LSU - KENNER MULTI - SPECIALTY

CLINIC (site 012)

PHY INTERNAL MEDICINE /

PEDIATRICS

S 3 0 164 2500 AGES 18 - 64200 WEST ESPLANADE AVENUE,


(504)412-1705

1444944-012

BORNE, DAVID, MD - 1969095

LO, BETTY, MD - 1986496

MCLEAN, ANGELA, MD - 1664499

KENNER LSU FAMILY MEDICINE KENNER (site

009)

PHY FAMILY PRACTICE K 4 0 749 2500 AGES 0 - 64200 WEST ESPLANADE AVENUE,

#412, KENNER - 70065

(504)471-2750

1444944-009

CAMPBELL, JR., JAMES, MD - 1428353

DAWSON - CASWELL, MARIN, MD - 1020460

STARR, SHANNON, MD - 1131580

WILLIAMS, DAVE, MD - 1547506

KENNER MAYORGA CHRISTIAN PHY FAMILY PRACTICE S 1 0 215 2500 AGES 21 - 644228 WILLIAMS BOULEVARD,


(504)305-0063

1662101-001

Page 2 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



KENNER MENDOZA R. C. PHY PEDIATRICS K 1 0 3480 2500 MAX CAPACITY

EXCEEDED; AGES 0 - 203100 WILLIAMS BOULEVARD,

KENNER - 70065

(504)443-5430

1191272-001

KENNER PATEL HARSHAD PHY INTERNAL MEDICINE S 1 0 187 2500 AGES 18 - 643321 FLORIDA AVENUE, KENNER

- 70065

(504)466-3702

1965952-001

KENNER PEDIATRIC MEDICAL CLINIC (site 002) PHY PEDIATRICS S 1 0 128 2500 AGES 0 - 202400 VETERANS BOULEVARD,


(504)305-3812

1449369-002

LAMBERT, OLIVER, MD - 1324906

KENNER PMA MEDICAL TREATMENT PHY GENERAL PRACTICE K 3 1 644 3000 AGES 6 MONTHS - 64

YEARS613 WILLIAMS BOULEVARD,

KENNER - 70062

(504)441-5555

1025119-001

BIUNNO, MICHAEL, MD - 1966746

GAUTREAUX, III, JOSEPH, MD - 1307505

GILMORE, BRANDI, MD - 1506877

PHILLIPS, RICKY, NP - 1029246

KENNER QUYNH MAI CLINIC LLC PHY FAMILY PRACTICE 2 0 387 5000 AGES 21 - 64705 WEST ESPLANADE AVENUE,

SUITE A, KENNER - 70065

(504)465-0185

1448940-001

MAI, QUYNH, MD - 1563030

VALDES, MICHAEL, MD - 1508080

KENNER RICHARDSON GLENDA PHY PEDIATRICS K 1 0 1164 2500 AGES 0 - 132100 THIRD STREET, SUITE 6,

KENNER - 70062

(504)466-1251

1301922-001

Page 3 of 233


REGION


CAP.

CURRENT

CC

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NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



KENNER ROMAGUERA (site 001) PEDRO PHY INTERNAL MEDICINE 1 0 254 2500 AGES 21 - 643800 HOUMA BOULEVARD, SUITE

350, KENNER - 70006

(504)465-2223

1932523-001

KENNER SMITH VICTORIA PHY FAMILY PRACTICE S 1 0 266 2500 AGES 12 - 644228 WILLIAMS BOULEVARD,


(504)496-0138

1570672-001

KENNER ST. CHARLES COMMUNITY HEALTH

CLINIC

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 5 4 1071 8500 AGES 0 - 64200 WEST ESPLANADE AVENUE,

#310 - 314, KENNER - 70065

(504)464-8759

1452904-001

COMBOY, MICHELLE, NP - 1000361

DAVILLIER, KELLY, MD - 1420565

DAWSON, ROBERT, MD - 1955191

DECOURSEY, MARY, CNM - 1507938

GANDHI, MOHAN, MD - 1334731

HADI, MOHAMMED, MD - 1106267

LEDET, CHRIS, NP - 1509108

SADEGHPOUR, BAHRAM, MD - 1385671

THOMAS, SOPHIA, NP - 1535516

KENNER VOIGHT JACK PHY GENERAL PRACTICE 1 0 374 2500 AGES 21 - 642424 WILLIAMS BOULEVARD,

SUITE K, KENNER - 70062

(504)466-9386

1455474-001

KENNER WILLIAMS CYNTHIA PHY OBGYN 1 0 63 2500 FEMALES ONLY, AGES 21

- 34200 WEST ESPLANADE AVENUE,


(504)464-8750

1323004-001

Page 4 of 233


REGION


CAP.

CURRENT

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NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



METAIRIE ANGELICA NICHOLAS PHY INTERNAL MEDICINE 1 0 47 47 CLOSED PANEL3800 HOUMA BOULEVARD, SUITE

350, METAIRIE - 70006

(504)885-2155

1198471-001

METAIRIE CAROUSEL PEDIATRICS APMC PHY PEDIATRICS K 3 0 82 150 LIMITED PANEL;

CURRENT PTS &

SIBLINGS AGES 0 - 20

4224 HOUMA BOULEVARD, #240,

METAIRIE - 70006

(504)885-4141

1348546-001

MCLEAN, ELLEN, MD - 1199702

RADEMACHER, JEANNE, MD - 1685933

TREADWAY, JAMES, MD - 1238091

METAIRIE CHILDREN'S CLINIC, LLC (site 001) PHY PEDIATRICS K 2 0 1356 5000 AGES 0 - 185037 VETERANS BOULEVARD,

SUITE 2E, METAIRIE - 70006

(504)887-2616

1445924-001

SHUJA, MUHAMMAD, MD - 1314366

STANLEY, EDATTUKARAN, MD - 1312371

METAIRIE CHILDREN'S HOSPITAL MEDICAL

PRACTICE (site 013)

PHY PEDIATRICS K 3 0 2799 7500 AGES 0 - 202201 VETERANS BOULEVARD,

SUITE 300, METAIRIE - 70002

(504)833-7374

1946711-013

BARBARA, III, JOHN, MD - 1358461

CULBERTSON, CARY, MD - 1483770

MORICI, MARK, MD - 1492205



PHY PEDIATRICS K 6 0 1639 15000 AGES 0 - 203040 33RD STREET, METAIRIE -

70001

(504)219-0880

1946711-007

BELLARD, KIRK, MD - 1168092

ESTES, JR., DAVID, MD - 1919098

HELLER, JR., MICHAEL, MD - 1489751

PERRIN, KEITH, MD - 1341355

SENENTZ, TAMMY, MD - 1492965

SOLIS, SAM, MD - 1340251

Page 5 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE





PHY PEDIATRICS K 7 0 2492 2492 CURRENT PATIENTS AND

NEWBORNS AGES 0 - 184740 SOUTH I - 10 SERVICE

ROAD, SUITE 200, METAIRIE -

70001(504)883-3703

1946711-009

ADAMS, ELIZABETH, MD - 1490148

BLAKE, WILLIAM, MD - 1174891

BRACEY, SCOTT, MD - 1579173

CASEY, JERRY, MD - 1982172

KAPPEL, KEITH, MD - 1349216

NEUMANN, CLAIRE, MD - 1424501

ZANDER, SCOTT, MD - 1181706



PHY PEDIATRICS K 2 0 731 731 OPEN AGES 0 - 2 MNTHS;

CURR PTS AGES 3MNTH -

17YRS

3100 KINGMAN STREET, SUITE

110, METAIRIE - 70006

(504)887-6355

1946711-011

LAWRENCE, REITA, MD - 1696463

MICHEL, JAIME, MD - 1055859

METAIRIE DAUGHTERS OF CHARITY HEALTH

CENTER - METAIRIE

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 3 1 902 5500 AGES 0 - 64111 NORTH CAUSEWAY

BOULEVARD, METAIRIE - 70001

(504)482-0084

1452840-001

DALCORSO, MARK, MD - 1367389

HOWARD, KRYSTAL, NP - 1333689

MADRIGAL, VINICIO, MD - 1350362

POST, ROBERT, MD - 1965651

METAIRIE DRS. LE BOEUF AND BURAS AMC PHY PEDIATRICS K 3 0 3124 7500 AGES 0 - 102800 VETERANS BOULEVARD,


(504)309-9364

1940305-001

BEVROTTE, LOUIS, MD - 1135640

BURAS, JR., FLOYD, MD - 1168548

LE BOUEF, RICHARD, MD - 1144835

Page 6 of 233


REGION


CAP.

CURRENT

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LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



METAIRIE FAMILY PRACTICE CENTER PHY FAMILY PRACTICE K 6 0 538 538 ACCEPTS NEW PTS

AGES 0-20, CURRENT

PTS AGES 21-64

4228 HOUMA BOULEVARD, SUITE

200, METAIRIE - 70006

(504)454-7878

1940089-001

ARCENEAUX - CASEY, LISA, MD - 1073172

CUCCHIARA, CHARLES, MD - 1103217

EUANS, DAVID, MD - 1315257

MAGONET, GORDON, MD - 1697796

RUSS, J. KEVIN, MD - 1329274

RYAN, ROBERT, MD - 1313122

METAIRIE HAROLD R. YORK MD APMC (site 003) PHY PEDIATRICS K 1 1 1454 2500 AGES 0 - 204937 HEARST STREET, SUITE 2 -

A, METAIRIE - 70001

(504)885-9957

1940062-003

BELL, AMY, NP - 1369721

YORK, HAROLD, MD - 1143804

METAIRIE LEVY LAWRENCE PHY INTERNAL MEDICINE 1 0 1 1 AGES 21 - 643800 HOUMA BOULEVARD, SUITE

325, METAIRIE - 70006

(504)888-7111

1310271-001

METAIRIE NETWORK PHYSICIANS PHY INTERNAL MEDICINE /

FAMILY PRACTICE

3 0 1 1 CLOSED PANEL4228 HOUMA BOULEVARD, #330,

METAIRIE - 70006

(504)456-5123

1445495-001

ANGELICO, BLAISE, MD - 1199508

FINNEY, JOHN, MD - 1351121

POLLOCK, ROBERT, MD - 1371076

Page 7 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



METAIRIE OCHSNER CHILDREN'S HEALTH

CENTER

PHY PEDIATRICS K 8 2 908 908 CURRENT PATIENTS,

NEWBORNS, & SIBLINGS

AGES 0 - 18

4901 VETERANS BOULEVARD,

METAIRIE - 70006

(504)887-1133

1445223-002

BROWN, SAMIRA, MD - 1193534

CALIX, DANIELLE, MD - 1421383

DEFUSCO, LISA, MD - 1050962

GLICK, AMY, MD - 1560359

GRANIER, PATRICIA, MD - 1687146

RUDOLPH, AMANDA, NP - 1552992

SEOANE, MICHELLE, MD - 1485021

SWAIN, KATHERINE, MD - 1192929

TIGERT, NANCY, NP - 1535923

WASSERMAN, MICHAEL, MD - 1304794

METAIRIE OKOLE SAMMY PHY FAMILY PRACTICE 1 0 40 2500 AGES 21 - 645500 VETERANS BOULEVARD,


(504)887-7792

1480983-001

METAIRIE PARIKH PARIMAL PHY INTERNAL MEDICINE 1 0 126 2500 AGES 21 - 643800 HOUMA BOULEVARD, SUITE

308, METAIRIE - 70006

(504)457-2577

1673471-001

METAIRIE SUNNYSIDE PEDIATRICS LLC PHY PEDIATRICS K 2 0 1637 5000 AGES 0 - 204420 CONLIN STREET, SUITE 205,

METAIRIE - 70006

(504)455-8887

1033332-001

DEAGUIAR, ANA, MD - 1173525

VERAS - POLA, JOSE, MD - 1025101

Page 8 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



METAIRIE SUNRISE PEDIATRICS PHY PEDIATRICS K 4 0 600 600 CURRENT PATIENTS,


AGES 0 - 20

3116 6TH STREET, SUITE 101,

METAIRIE - 70002

(504)837-9000

1940534-001

BUSENLENER, TANYA, MD - 1699705

DANNA, III, NICHOLAS, MD - 1187763

DEFRANCE, DIANE, MD - 1917150

MASCARENHAS, VIMALA, MD - 1906760

METAIRIE TRAN MEDICAL ASSOCIATES PHY FAMILY PRACTICE 2 0 412 412 CLOSED PANEL3848 VETERANS BOULEVARD,


(504)885-2505

1011894-001

DUNG, HOANG, MD - 1140414

TRAN, DUNG, MD - 1123897

METAIRIE TUHC GENERAL PEDIATRICS (site 001) PHY PEDIATRICS K 7 0 1296 7500 AGES 0 - 204770 I - 10 SERVICE ROAD, SUITE

501, METAIRIE - 70001

(504)988-8000

1444910-001

ABDALIAN, SUSAN, MD - 1372480

ALCHEDIAK, THOMAS, MD - 1367737

DOUCET, III, HOSEA, MD - 1194891

EVERS, PATRICE, MD - 1499463

KNIGHT, KATHERINE, MD - 1155055

MORGAN, DELIA, MD - 1488534

SILIO, MARGARITA, MD - 1983535

METAIRIE TULANE CENTER FOR WOMENS

HEALTH

PHY OBGYN S 5 0 316 5000 FEMALES ONLY, AGES 13

- 644720 SOUTH I - 10 SERVICE ROAD

WEST, SUITE 300, METAIRIE -

70001(504)988-8070

1443719-007

BHALANI, VAISHALI, MD - 1423891

GOLLIN, ROBERTA, MD - 1341983

HERRERA, EDUARDO, MD - 1367401

REITAN, RACHEL, MD - 1485543

VAN OPIJNEN, ROELAND, MD - 1498157

Page 9 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



METAIRIE TULANE GENERAL PEDIATRICS (site

001)

PHY PEDIATRICS S 6 0 926 5000 AGES 0 - 204720 SOUTH I - 10 SERVICE

ROAD, SUITE 501, METAIRIE -

70001(504)988-8000

1443719-001






WEIMER, STEPHEN, MD - 1662003

METAIRIE WILLIAM ST. JOHN LACORTE, APMC PHY INTERNAL MEDICINE 1 1 120 120 CURRENT PATIENTS

AGES 21 - 64519 METAIRIE ROAD, METAIRIE -

70005

(504)838-6000

1944556-001

LACORTE, WILLIAM, MD - 1196509

TOUPS, MELANIE, NP - 1134546

RIVER RIDGE CHILDREN'S HOSPITAL MEDICAL


PHY PEDIATRICS K 3 0 1851 7500 AGES 0 - 209605 JEFFERSON HIGHWAY,

RIVER RIDGE - 70123

(504)738-1604

1946711-008

DOSKEY, RICHARD, MD - 1383171

FIRESTONE, JR., JOHN, MD - 1368458

LISSARD, JANINE, MD - 1484911

JEFFERSON-WEST BANK

AVONDALE JEFFERSON COMMUNITY HEALTH

CARE CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 4 1 901 10000 AGES 0 - 644028 U. S. HIGHWAY 90 WEST,

AVONDALE - 70094

(504)436-2223

1452793-001

ALLEN, RENETTA, NP - 1453129

CUROLE, DAVID, MD - 1171433

DUMAS, JEREMY, MD - 1579378

PANDIT, BHARATHI, MD - 1656828

WOLFSON, NEIL, MD - 1138754

Page 10 of 233


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NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

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SPECIALTY

PROV.

TYPE



GRETNA BETTENCOURTT HEATH PHY PEDIATRICS K 1 0 1011 2500 AGES 0 - 17145 LAPALCO BOULEVARD,

SUITE B, GRETNA - 70056

(504)392-2580

1483095-001

GRETNA BOUCHETTE ALIX PHY FAMILY PRACTICE S 1 0 1023 2500 AGES 0 - 64230 MEADOWCREST STREET,

GRETNA - 70056

(504)392-5997

1378313-001

GRETNA DANG THIEM PHY FAMILY PRACTICE S 1 0 223 223 CLOSED PANEL1221 AMELIA STREET, GRETNA -

70053

(504)364-1844

1339229-001

GRETNA FISHER MARC PHY PEDIATRICS K 1 0 984 2500 AGES 0 - 2012 A WESTBANK EXPRESSWAY,

SUITE 100, GRETNA - 70053

(504)361-0234

1379468-001

GRETNA FORTINO JAMES PHY PEDIATRICS K 1 0 1045 2500 AGES 0 - 201301 WHITNEY AVENUE, GRETNA

- 70056

(504)367-8777

1061786-001

GRETNA MICHAEL HAYDEL MD AMC (site 002) PHY PEDIATRICS K 2 0 2386 2500 AGES 0 - 20120 MEADOWCREST STREET,

GRETNA - 70056

(504)391-7565

1446602-002

FANTACI, LINDSAY, MD - 1060810

HAYDEL, MICHAEL, MD - 1159549

Page 11 of 233


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NO.

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*

KM

SVC

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SPECIALTY

PROV.

TYPE



GRETNA NGUYEN HAI NAM PHY INTERNAL MEDICINE K 1 0 1324 2500 AGES 0 - 201221 AMELIA STREET, GRETNA -

70053

(504)364-1844

1492337-001

GRETNA PEDIATRIC CLINIC - WESTBANK PHY PEDIATRICS K 3 0 5187 7500 AGES 0 - 17151 MEADOWCREST, SUITE F,

GRETNA - 70056

(504)392-9298

1945242-001

BANUCHI, GRACE, MD - 1321443

DARGAN, SURBHI, MD - 1390666

THALY, KAMALAKANT, MD - 1312606

GRETNA PEDIATRIC KIDMED, LLC PHY PEDIATRICS K 3 0 3365 7500 AGES 0 - 16120 MEADOWCREST, SUITE 245,

GRETNA - 70056

(504)391-7690

1948012-001

ANAND, HARISH, MD - 1183636

BURBANK, DEREGAL, MD - 1324230

SHARMA, RAJESH, MD - 1676489

GRETNA VALENTINE MEDICAL CENTER PHY INTERNAL MEDICINE K 1 1 726 3000 AGES 0 - 641620 BELLE CHASSE HIGHWAY,

#102 A, GRETNA - 70056

(504)363-4711

1179370-001

MANDHARE, VIDYA, NP - 1782661

VALENTINE, CHRISTY, MD - 1424927

HARVEY LE CAC THANH PHY PEDIATRICS K 1 0 1660 2500 AGES 0 - 18851 MANHATTAN BOULEVARD,

SUITE A, HARVEY - 70058

(504)368-4396

1366277-001

HARVEY TRUYEN T. VU APMC PHY PEDIATRICS /

INTERNAL MEDICINE

K 2 0 1971 5000 AGES 0 - 203709 WESTBANK EXPRESSWAY,

SUITE 1 B, HARVEY - 70058

(504)348-2310

1446734-001

VU, QUANG, MD - 1482366

VU, TRUYEN, MD - 1311073

Page 12 of 233


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NO. OF

PHYS.

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NO.

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*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MARRERO CHILDREN'S MEDICAL CLINIC PHY PEDIATRICS K 2 0 2868 5000 AGES 0 - 20829 BARATARIA BOULEVARD,

MARRERO - 70072

(504)368-7337

1446319-001

ARNAUD, STEPHANIE, MD - 1074772

ST. ETIENNE, ROSELYNN, MD - 1564362

MARRERO GANJI PRAMELA PHY FAMILY PRACTICE 1 0 654 2500 AGES 21- 641111 MEDICAL CENTER

BOULEVARD, SUITE S - 555,

MARRERO - 70072(504)349-6325

1669172-001

MARRERO JEFFERSON COMMUNITY HEALTH

CARE CENTER, FQHC

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 4 1 450 8000 AGES 0 - 641855 AMES BOULEVARD, SUITE

B, MARRERO - 70072

(504)340-2337

1015199-001

ALLEN, RENETTA, NP - 1453129

CUROLE, DAVID, MD - 1171433

DUMAS, JEREMY, MD - 1579378

PRICE, GENELLE, MD - 1485446

WARRIER, JAYA, MD - 1656810

MARRERO JEFFERSON PEDIATRIC CLINIC PHY PEDIATRICS K 1 0 1567 1567 CURRENT PATIENTS

AGES 0 - 201111 MEDICAL CENTER

BOULEVARD, SUITE 813,

MARRERO - 70072(504)349-6813

1799815-001

TRUJILLO, CARLOS, MD - 1335436

MARRERO MICHAEL G RUSSO MD A

PROFESSIONAL MEDICAL

CORPORATION

PHY FAMILY PRACTICE 1 1 608 2500 AGES 21 - 641111 MEDICAL CENTER, SOUTH

TOWER #555, MARRERO - 70072

(504)367-8577

1347761-001

NORMAN, JOANN, NP - 1025577

RUSSO, MICHAEL, MD - 1987051

Page 13 of 233


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PHYS.

EXT.

NO.

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PHYS.

*

KM

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PROVIDER

SPECIALTY

PROV.

TYPE



MARRERO MICHAEL HAYDEL MD AMC (site 001) PHY PEDIATRICS K 3 0 1835 2500 AGES 0 - 201111 MEDICAL CENTER

BOULEVARD, N208, MARRERO -

70072(504)349-6228

1446602-001

CAPONE, KENNETH, MD - 1312151

FANTACI, LINDSAY, MD - 1060810

HAYDEL, MICHAEL, MD - 1159549

MARRERO REMEDIOS OTHOLINO PHY PEDIATRICS K 1 0 581 2500 AGES 0 - 201200 AVENUE G, MARRERO -

70072

(504)347-0202

1957798-001

MARRERO TURNER JULES PHY PEDIATRICS K 1 0 595 2500 AGES 0 - 204520 WICHERS DRIVE, SUITE 205,

MARRERO - 70072

(504)371-0676

1482251-001

MARRERO WESTCARE MEDICAL CENTER (site 001) PHY GENERAL PRACTICE S 3 1 2311 5500 AGES 0 - 641220 BAVATARIA BOULEVARD,

MARRERO - 70072

(504)340-6711

1941433-001

BECNEL, ROLAND, NP - 1538159

FRILEY, MICHAEL, MD - 1123188

PROCELL, BILL, MD - 1329118

YANCY, BRIGETTA, MD - 1552011

MARRERO WESTSIDE CLINICS, AMC (site 001) PHY PEDIATRICS K 8 0 4515 5000 AGES 0 - 207017 LAPALCO BOULEVARD,

MARRERO - 70072

(504)391-7337

1440574-001

BOSTICK, ROBERT, MD - 1118796

BRAGG, JULIE, MD - 1483214

GUY, ROBERT, MD - 1118788

LEONE, DEAN, MD - 1986488

MCARTHUR, DONALD, MD - 1107972

NICK, BRENT, MD - 1901806

VIGOUR, EMILY, MD - 1062855

WATTS, CHARLES, MD - 1300721

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MARRERO WESTSIDE CLINICS, AMC (site 002) PHY PEDIATRICS S 8 0 3098 25000 AGES 0 - 204225 LAPALCO BOULEVARD,

MARRERO - 70072

(504)391-7337

1440574-002

BOSTICK, ROBERT, MD - 1118796

BRAGG, JULIE, MD - 1483214

GUY, ROBERT, MD - 1118788

LEONE, DEAN, MD - 1986488

MCARTHUR, DONALD, MD - 1107972

NICK, BRENT, MD - 1901806

VIGOUR, EMILY, MD - 1062855

WATTS, C. HUNTER, MD - 1300721

WESTWEGO WESTCARE MEDICAL CENTER (site 002) PHY GENERAL PRACTICE K 2 1 2169 5500 AGES 0 - 64712 WESTBANK EXPRESSWAY,

WESTWEGO - 70094

(504)340-7744

1941433-002

ARNOLD, JEFFREY, NP - 1173329

DU, TRI, MD - 1051039

PROCELL, WILLIAM, MD - 1329118

ORLEANS

ALGIERS ALGIERS COMMUNITY HEALTH CLINIC FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 5 0 1404 10000 AGES 0 - 641111 NEWTON STREET, 1ST

FLOOR, ALGIERS - 70114

(504)658-2550

1941191-001

EDWARDS, DANYEL, MD - 1090263

GONZALES, LOLITA, MD - 1534617

IMSEIS, EMANUEL, MD - 1157481

SHALABY, MONA, MD - 1377121

SHALABY, MONIR, MD - 1368199

NEW ORLEANS ADVANCED CLINICAL CONSULTANTS PHY FAMILY PRACTICE 1 1 24 500 AGES 21 - 643715 PRYTANIA STREET, SUITE

230, NEW ORLEANS - 70115

(504)894-8307

1013561-001

LACORTE, WILLIAM, MD - 1196509

LAWSON, SCHARMAINE, NP - 1156469

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NEW ORLEANS ALFEREZ TLALOC PHY INTERNAL MEDICINE 1 0 63 2500 AGES 21 - 643405 ST. CLAUDE AVENUE, NEW

ORLEANS - 70117

(504)267-0632

1362077-001

NEW ORLEANS BARNES JANET PHY PEDIATRICS K 1 0 1451 2500 AGES 0 - 203600 PRYTANIA STREET, SUITE


(504)891-1800

1320714-001

NEW ORLEANS BARNES SHELTON PHY INTERNAL MEDICINE S 1 0 563 2500 AGES 15 - 643600 PRYTANIA STREET, SUITE


(504)891-1800

1196975-001

NEW ORLEANS BAWA GURMUKH PHY GENERAL PRACTICE S 1 0 1411 2500 AGES 2 - 641553 NORTH BROAD STREET,

NEW ORLEANS - 70119

(504)943-9222

1373915-001

NEW ORLEANS CAPONE KEITH PHY PEDIATRICS K 1 0 93 93 CLOSED PANEL6517 SPANISH FORT

BOULEVARD, NEW ORLEANS -

70124(504)283-7306

1385999-001

NEW ORLEANS CHILDREN'S CLINIC OF NEW ORLEANS

(site 001)

PHY PEDIATRICS K 2 0 2516 5000 AGES 0 - 203201 GENERAL MEYER AVENUE,

SUITE C, NEW ORLEANS - 70114

(504)362-8930

1942111-001

CRESSWELL, ANGELLE, DO - 1882577

GOURI, THATTIL, MD - 1194620

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NEW ORLEANS CHILDREN'S CLINIC OF NEW ORLEANS

(site 002)

PHY PEDIATRICS K 2 0 60 5000 AGES 0 - 202101 BANKS STREET, NEW

ORLEANS - 70112

(504)523-4357

1942111-002

CRESSWELL, ANGELLE, DO - 1882577

GOURI, THATTIL, MD - 1194620

NEW ORLEANS CHILDREN'S HOSPITAL MEDICAL


PHY PEDIATRICS K 3 0 3567 7500 AGES 0 - 203600 PRYTANIA, SUITE 100, NEW

ORLEANS - 70115

(504)899-5437

1946711-002

DAWKINS, RACHEL, MD - 1074837

ROBINSON, CARL, MD - 1127566

ROBINSON, SANDRA, MD - 1127558



PHY PEDIATRICS K 6 0 3121 5000 AGES 0 - 202820 NAPOLEON AVENUE, SUITE


(504)897-4242

1946711-006

BELLARD, KIRK, MD - 1168092

ESTES, JR., DAVID, MD - 1919098

HELLER, JR., MICHAEL, MD - 1489751

PERRIN, KEITH, MD - 1341355

SENENTZ, TAMMY, MD - 1492965

SOLIS, SAM, MD - 1340251



PHY PEDIATRICS K 6 0 2478 2478 AGES 0 - 18; CURR PTS

19 - 201661 CANAL STREET, SUITE 1200,

NEW ORLEANS - 70112

(504)299-9980

1946711-012

BERRY, SUSAN, MD - 1399710

KHOURI, ANAS, MD - 1683574

LEFEVRE, SUZANNE, MD - 1491756

NASS, MELISSA, MD - 1165417

PASTERNAK, RYAN, MD - 1576328

ROJAS, PAULINA, MD - 1485616



PHY PEDIATRICS K 1 0 1435 2500 AGES 0 - 204052 ULLOA STREET, NEW

ORLEANS - 70119

(504)488-7505

1946711-015

POREE - TURNER, CECILY, MD - 1332372

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PHY PEDIATRICS K 1 0 600 2500 AGES 0 - 2014401 CHEF MENTEUR HIGHWAY,

NEW ORLEANS - 70129

(504)662-0644

1946711-016

HINZ, TAMI, MD - 1573272



PHY PEDIATRICS K 1 0 128 2500 AGES 0 - 203512 LOUISA STREET, NEW

ORLEANS - 70126

(504)948-2873

1946711-017

FARLEY, ALICE, MD - 1901580

NEW ORLEANS CITY OF NEW ORLEANS - EDNA

PILSBURY

PHY PEDIATRICS K 2 0 1389 5000 AGES 0 - 642222 SIMON BOLIVAR AVENUE,

2ND FLOOR, NEW ORLEANS -

70113(504)658-2825

1441449-004

DARKEN, MARY, MD - 1381152

GRANT, TELITHA, MD - 1069973

NEW ORLEANS CITY OF NO EAST FAMILY HHC PHY MULTI - SPECIALTY

CLINIC

K 3 0 269 5000 AGES 0 - 645640 READ BOULEVARD, SUITE


(504)658-2750

1337277-001

DEL - PORTAL, OSCAR, MD - 1392936

GONZALES, LOLITA, MD - 1534617

PRANIKOFF, LINCOLN, MD - 1952877

NEW ORLEANS CRESCENT CITY PEDIATRICS PHY PEDIATRICS K 2 0 2608 5000 AGES 0 - 18320 NORTH CARROLLTON

AVENUE, SUITE 103, NEW

ORLEANS - 70119(504)486-5151

1442518-001

JOHNSTON, GINA, MD - 1489948

REED, TANYA, MD - 1570575

NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site

001)

PHY INTERNAL MEDICINE S 2 0 604 800 LIMITED PANEL; AGES 14

- 643434 PRYTANIA STREET, #460,

NEW ORLEANS - 70115

(504)897-7999

1943479-001

BRENNER, JOSEPH, MD - 1113212

LEGE, CHRISTOPHER, MD - 1480428

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002)

PHY INTERNAL MEDICINE S 4 0 627 10000 AGES 14 - 643434 PRYTANIA STREET, #430,

NEW ORLEANS - 70115

(504)897-8118

1943479-002

BORGMAN, THEODORE, MD - 1088030

KOSSOVER, MELVYN, MD - 1033847

RUSSELL, JR, HOWARD, MD - 1114308

YOUNT, BEVERLY, MD - 1141682


006)

PHY GYN S 1 0 299 350 LIMITED PANEL;

FEMALES ONLY, AGES 14

- 64

3525 PRYTANIA STREET, #206,

NEW ORLEANS - 70115

(504)897-8281

1943479-006

JACOB, JACK, MD - 1133191


007)

PHY FAMILY PRACTICE /

OBGYN

K 2 0 1021 5000 AGES 14 - 643322 ST. CLAUDE AVENUE, NEW

ORLEANS - 70117

(504)947-7754

1943479-007

BOUCHETTE, DANIEL, MD - 1389242

SHAH, SWATI, MD - 1481742


009)

PHY INTERNAL MEDICINE S 1 0 321 321 CURRENT PATIENTS

AGES 14 - 643701 BEHRMAN PLACE, SUITE


(504)367-6971

1943479-009

CURRIE, EVITA, MD - 1307262


010)

PHY FAMILY PRACTICE S 2 0 278 278 CLOSED PANEL9801 LAKE FORREST


70127(504)246-1452

1943479-010

COOPER, MICHELE, MD - 1693570

LABRANCHE, EMILE, MD - 1364843


011)

PHY INTERNAL MEDICINE S 1 0 96 100 AGES 14 - 643434 PRYTANIA STREET, SUITE


(504)897-7007

1943479-011

BERTSCH, JENNIFER, MD - 1483087

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012)

PHY FAMILY PRACTICE S 1 0 56 2500 AGES 14 - 64145 ROBERT E LEE BOULEVARD,

SUITE 402, NEW ORLEANS -

70124(504)304-7949

1943479-012

GODBEY, SHERRI, MD - 1166073

NEW ORLEANS CRUZ - FIELDS CLINIC PHY INTERNAL MEDICINE 4 0 13 13 CURRENT PATIENTS

AGES 21 - 643525 PRYTANIA STREET, SUITE


(504)897-4425

1940992-001

CRUZ, FRANCISCO, MD - 1425141

CRUZ, FRANK, MD - 1193402

FOX, APRIL, MD - 1579467

REGINELLI, ANGELA, MD - 1556050

NEW ORLEANS DAO MINH PHY INTERNAL MEDICINE K 1 0 1560 2500 AGES 0 - 644657 ALCEE FORTIER

BOULEVARD, SUITE A, NEW

ORLEANS - 70129(504)254-4011

1675261-001

NEW ORLEANS FLOYD FREDRICK PHY INTERNAL MEDICINE 1 0 418 2500 AGES 21 - 642909 ST. CLAUDE AVENUE, NEW

ORLEANS - 70117

(504)942-1167

1487945-001

NEW ORLEANS GALVEZ DOCTORS CLINIC PHY INTERNAL MEDICINE S 3 0 325 2500 AGES 0 - 641407 PIETY STREET, NEW

ORLEANS - 70117

(504)940-0820

1445258-001

ALFEREZ, TLALOC, MD - 1362077

DAVIS, ANNA, MD - 1185116

WILEY, KENNETH, MD - 1965669

NEW ORLEANS GARAUDY ANDREA PHY PEDIATRICS K 1 0 166 166 CLOSED PANEL; LIMITED

PANEL; AGES 0 - 206517 SPANISH FORT


70124(504)283-7306

1043991-001

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NEW ORLEANS HACKETT JUDITH PHY FAMILY PRACTICE K 1 0 863 2500 AGES 0 - 641901 LEONIDAS STREET, NEW

ORLEANS - 70118

(504)865-1539

1330965-001

NEW ORLEANS HUNTER MICHAEL PHY FAMILY PRACTICE 1 0 383 383 CURRENT PATIENTS

AGES 21 - 642714 CANAL STREET, SUITE 201,

NEW ORLEANS - 70119

(504)822-1092

1358151-001

NEW ORLEANS JASE ANTHONY PHY INTERNAL MEDICINE 1 0 214 2500 AGES 21 - 641215 NORTH BROAD STREET,

NEW ORLEANS - 70119

(504)483-7112

1575691-001

NEW ORLEANS LEADING EDGE SERVICES

INTERNATIONAL, INC.

PHY MULTI - SPECIALTY

CLINIC

K 2 1 293 2500 AGES 0 - 641501 NEWTON STREET, SUITE C,

NEW ORLEANS - 70114

(504)361-3777

1455822-001

CRUZ, JORGE, MD - 1508012

HAGANS, JARITA, MD - 1309184

IMUDIA, ANTHONIA, NP - 1625108

NEW ORLEANS LIN (site 001) EDWIN PHY PEDIATRICS K 1 0 2109 2500 AGES 0 - 204209 ST. CLAUDE AVENUE, NEW

ORLEANS - 70117

(504)944-0144

1300195-001

NEW ORLEANS LOUISIANA AVENUE MEDICAL CENTER

INC

PHY GENERAL PRACTICE K 1 2 1094 2500 AGES 0 - 644301 ELYSIAN FIELDS AVENUE,

NEW ORLEANS - 70122

(504)284-3866

1942421-001

BARCONEY, MONIQUE, NP - 1032239

EVANS, JR, HENRY, MD - 1133582

LANDRY - SANCHEZ, VANESSA, PA - 1712663

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NEW ORLEANS LOUISIANA HEALTHCARE INITIATIVE,

LLC


FAMILY PRACTICE

1 1 22 500 AGES 21 - 64211 NORTH JEFFERSON DAVIS

PARKWAY, NEW ORLEANS -

70119(504)483-9858

1072605-001

LEJEMTEL, THIERRY, MD - 1473251

WHITE, SABRINA, NP - 1468517

NEW ORLEANS LSU BAPTIST UPTOWN PHY INTERNAL MEDICINE K 4 0 687 2500 AGES 0 - 642820 NAPOLEON AVENUE, SUITE


(504)412-1366

1444944-002

LO - BLAIS, BETTY, MD - 1986496

MCDERMOTT, DIANA, MD - 1065447

SPILLER, CATHERINE, MD - 1422118

WALLIS, JOHN, MD - 1422355

NEW ORLEANS LSU HOP CLINIC MCLNO (site 010) PHY INTERNAL MEDICINE B 7 0 294 5500 AGES 0 - 64136 SOUTH ROMAN STREET,

NEW ORLEANS - 70112

(504)903-6959

1444944-010

BESCH, CERYL, MD - 1307106

CLARK, REBECCA, MD - 1392847

HAGENSEE, MICHAEL, MD - 1532347

LOPEZ, ALFREDO, MD - 1542067

MAFFEI, JOANNE, MD - 1995665

RUIZ, MARCO, MD - 1074101

WILCOX, RONALD, MD - 1493406

NEW ORLEANS LSU MEDICINE @ LORD & TAYLOR PHY INTERNAL MEDICINE 4 0 660 5000 AGES 21 - 641450 POYDRAS STREET, 3RD

FLOOR, NEW ORLEANS - 70115

(504)903-2373

1444944-006

BORNE, DAVID, MD - 1969095

EUBANKS, JR., ROBERT, MD - 1966991

HART, JENNIFER, MD - 1966258

MCLEAN, ANGELA, MD - 1664499

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NEW ORLEANS MACARTHUR PRIMARY CARE CENTER PHY INTERNAL MEDICINE S 2 0 148 500 LIMITED PANEL; CURR

PTS & FAMILY MEMBERS

AGES 0-64

3712 MACARTHUR BOULEVARD,


70114(504)368-4066

1443263-001

DREZ, CHERIE, MD - 1483931

YURATICH, PAUL, MD - 1916609

NEW ORLEANS MCLNO - FREDERICK DOUGLAS

SENIOR HIGH SCHOOL


CLINIC

K 10 8 105 3000 AGES 0 - 643815 BURGUNDY STREET, NEW

ORLEANS - 70112

(504)942-5952

1444766-003

BACON, GLORIA, MD - 1010375

BOURGEOIS, LIONEL, MD - 1656801

BROUSSARD, MARY, NP - 1030210

CHATMAN, PATRICIAN, NP - 1471054

DIMITRY, ELIZABETH, NP - 1436241

FOXWORTH, GWENDOLYN, NP - 1562793

GREEN, STACY, MD - 1424196

HARRIS, MIA, MD - 1070068

HARVEY - FIELDS, ANTOINETTE, MD - 1422096

JARRETT, DEBBIE, NP - 1680982

KING, MICHAELA, MD - 1061344

MAXWELL, BARBARA, NP - 1196584

MELENDEZ - RAMI, LYDIA, MD - 1074047

MORNAY, YOLANDA, NP - 1056316

ROUSSEAU, MARCELLE, MD - 1073881

RUSSO, EMILO, MD - 1345679

WILLIAMS, SHONDRA, NP - 1106836

YOURMAN, CASSANDRA, MD - 1392952

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NEW ORLEANS MCLNO - JACKSON BARRACKS PHY MULTI - SPECIALTY

CLINIC

K 10 8 93 3000 AGES 0 - 646460 NORTH CLAIBORNE

AVENUE, NEW ORLEANS - 70117

(504)278-7330

1444766-004




CHATMAN, PATRICIA, NP - 1471054












RUSSO, EMILIO, MD - 1345679



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NEW ORLEANS MCLNO - MARTIN BEHRMAN PHY MULTI - SPECIALTY

CLINIC

S 10 8 64 3000 AGES 0 - 64715 OPELOUSAS AVENUE, NEW

ORLEANS - 70114

(504)361-6442

1444766-005



















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NEW ORLEANS MCLNO - MURRY HENDERSON PHY MULTI - SPECIALTY

CLINIC

K 10 8 235 3000 AGES 0 - 641912 L B LANDRY STREET, NEW

ORLEANS - 70114

(504)361-6300

1444766-006



















NEW ORLEANS MCLNO / TULANE - MEDICINE GROUP

(site 002)

PHY INTERNAL MEDICINE 7 0 201 5000 AGES 21 - 641450 POYDRAS AVENUE, 3RD


(504)988-2618

1444863-002

ALPER, ALYS, MD - 1498416

COOPER, JAN, MD - 1366374

DENNAR, PRINCESS, MD - 1104647

EVANS, BLACKWELL, MD - 1318175

LEDOUX, ELMA, MD - 1377261

VENDITTO, ALEGRA, MD - 1424943

WYCHE, MICHON, MD - 1653314

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NEW ORLEANS MCLNO / TULANE HOP PEDIATRIC

ADOLESCENT

PHY PEDIATRICS K 3 0 16 2500 AGES 0 - 24136 SOUTH ROMAN STREET, 4TH

FLOOR MC CLINIC, NEW

ORLEANS - 70112(504)903-6959

1444863-004

ABDALIAN, SUE ELLEN, MD - 1372480



NEW ORLEANS MCNEIL KIMBERLY PHY PEDIATRICS K 1 0 1354 2500 AGES 0 - 205640 READ BOULEVARD, SUITE


(504)244-0022

1485039-001

NEW ORLEANS MEDICAL SPECIALISTS OF TOURO, INC PHY INTERNAL MEDICINE /

FAMILY PRACTICE

4 0 455 5000 AGES 21 - 64, NOT

AFFILIATED WITH TOURO

INFIRMARY

3525 PRYTANIA STREET, SUITE


(504)897-4017

1444171-001

ALTMAN, IVAN, MD - 1925365

HEIMAN, MAYER, MD - 1087238

KADAN, SAVITRI, MD - 1199435

SMITH, BARBARA, MD - 1198234

NEW ORLEANS MIDTOWN MEDICAL, LLC PHY OBGYN 3 0 729 5000 WOMEN ONLY AGES 21 -

603500 ST. CHARLES AVENUE,


70115(504)895-0990

1529508-001

COLEMAN, ADRIAN, MD - 1423980

VARNISHUNG, KIAT, MD - 1199192

WORK, KEVIN, MD - 1058996

NEW ORLEANS MOLDEN GREGORY PHY INTERNAL MEDICINE 1 0 412 2500 AGES 21 - 642121 MAGAZINE STREET, NEW

ORLEANS - 70130

(504)592-9818

1363944-001

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NEW ORLEANS NO / AIDS TASK FORCE PHY INFECTIOUS DISEASE

/ FAMILY PRACTICE

S 1 2 58 3500 AGES 18 - 642601 TULANE AVENUE, SUITE


(504)821-2601

1141356-001

GOOTEE, MARY, NP - 1550493

MURPHY, MARY, MD - 1132900

PINDARO, CAROLE, NP - 1685534

NEW ORLEANS NOHC - CENTRAL CITY HEALTH

CENTER

PHY PEDIATRICS /

GENERAL PRACTICE

K 1 0 1403 2500 AGES 0 - 642222 SIMON BOLIVAR, 1ST


(504)571-1607

1155381-001

BARTHE, ANGELA, MD - 1968854

NEW ORLEANS NOHD HEALTHCARE FOR THE

HOMELESS

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

1 1 23 100 LIMITED PANEL; AGES 21

- 642222 SIMON BOLIVAR, 2ND


(504)658-2785

1940810-001

JONES, FLORENCE, MD - 1097501

PRESTON, IONE, NP - 1774545

NEW ORLEANS NOLA HEALTH SOLUTIONS LLC PHY FAMILY PRACTICE 2 0 69 5000 AGES 21 - 642610 ESPLANADE AVENUE,

SUITE B, NEW ORLEANS - 70119

(504)482-2294

1027693-001

ADDERLY, THREASA, MD - 1909611

LAMID, SOFJAN, MD - 1664201

NEW ORLEANS OCHSNER FOR CHILDREN MAIN

CAMPUS

PHY PEDIATRICS K 6 0 1345 1345 CURRENT PATIENTS AND

SIBLINGS AGES 0 - 171315 JEFFERSON HIGHWAY,

NEW ORLEANS - 70121

(504)842-3900

1445223-001

BRONFIN, DANIEL, MD - 1367940

JACKSON, AMANDA, MD - 1626503

KANTROW III, CHARLES, MD - 1976580

PARKERSON, JENNIFER, MD - 1370002

REYMOND, RENEE, MD - 1154610

SHOURBAJI, NAGLAA, MD - 1323560

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NEW ORLEANS OGBUOKIRI GODWIN PHY GENERAL PRACTICE K 1 0 914 2500 AGES 6 - 644543 DOWNMAN ROAD, NEW

ORLEANS - 70126

(504)246-5227

1433233-001

NEW ORLEANS PEDIATRIC ASSOCIATES OF NEW

ORLEANS

PHY PEDIATRICS K 1 0 2246 2500 AGES 0 - 20; ACCEPTING

NEW PTS AGES 0 - 18

ONLY

4511 DOWMAN ROAD, NEW

ORLEANS - 70126

(504)245-4000

1940496-001

DOUGHTY - WHITE, LINDA, MD - 1005132

NEW ORLEANS ST. THOMAS COMMUNITY HEALTH

CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 4 0 1198 10000 AGES 0 - 641020 ST. ANDREW, NEW

ORLEANS - 70130

(504)529-5558

1342921-001

ABELL, MARY, MD - 1361283

ERNY, EIRINN, MD - 1057134

FARLEY, ALICE, MD - 1901580

HEBERT, CATHERINE, MD - 1484458

NEW ORLEANS TANGPRICHA VITHAVAS PHY PEDIATRICS K 1 0 2114 2500 AGES 0 - 174209 ST. CLAUDE AVENUE, NEW

ORLEANS - 70117

(504)944-0144

1130788-001

NEW ORLEANS TILLERY, JR. BERTRAND PHY GENERAL PRACTICE K 1 0 1112 2500 AGES 0 - 643712 MACARTHUR BOULEVARD,


70114(504)365-9906

1576794-001

Page 29 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



NEW ORLEANS TUHC FAMILY HEALTH W/ OBGYN (site

003)

PHY FAMILY PRACTICE K 10 0 279 300 MATERNAL PTS & THEIR

MINOR CHILDREN AGES

0 - 39

200 BROADWAY, SUITE 230, NEW

ORLEANS - 70118

(504)988-9000

1444910-003


CUMMINGS, TERRY, MD - 1966380

DENNARD, EDWIN, MD - 1557056

DISE, THERESA, MD - 1378291

LOMBARD, AZIKIWE, MD - 1170321

PEJIC, RADE, MD - 1464431

SINGLETON, RENEE, MD - 1493040

STREIFFER, RICHARD, MD - 1908215

VALENCIA, VICTORIA, MD - 1098990

WISEMAN, PAMELA, MD - 1684660

NEW ORLEANS TUHC MED PEDS CLINIC PHY PEDIATRICS K 5 1 1371 3000 AGES 0 - 64275 LASALLE STREET, NEW

ORLEANS - 70112

(504)988-5030

1444910-005

BORIS, NEIL, MD - 1661384

CONRAD, TRACY, DO - 1499218

CRAFT, LISA, NP - 1554367

DENNAR, PRINCESS, MD - 1104647

HEBERT, COREY, MD - 1488127

ROTHWELL, WILLIAM, MD - 1173916

NEW ORLEANS TULANE COMMUNITY HEALTH CENTER

NEW ORLEANS EAST

PHY 3 0 20 2500 AGES 21 - 644626 ALCEE FORTIER, SUITE D,

NEW ORLEANS - 70129

(504)255-8665

1443719-017

JOPLIN, CHRISTOPHER, MD - 1061298

NGUYEN, TUAN, MD - 1238848

WINFREY, KEITH, MD - 1574325

Page 30 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



NEW ORLEANS TULANE DOWNTOWN GENERAL

PEDIATRICS

PHY PEDIATRICS S 4 0 98 2500 AGES 0 - 201415 TULANE AVENUE, 5TH


(504)988-6253

1443719-016





NEW ORLEANS TULANE DROP IN CLINIC AT COVENANT

HOUSE

PHY K 7 1 360 2500 AGES 0 - 23611 NORTH RAMPART STREET,

NEW ORLEANS - 70112

(504)584-1112

1443719-015



BONIN, EDWARD, NP - 1693065



FINGER, JULIE, MD - 1464023



NEW ORLEANS TULANE FAMILY PRACTICE WITHOUT

OBSTETRICS (site 014)

PHY FAMILY PRACTICE S 7 0 328 400 LIMITED PANEL; NO OB

PATIENTS; AGES 0 - 64200 BROADWAY, SUITE 230, NEW

ORLEANS - 70118

(504)988-9000

1443719-014

DENNARD, EDWIN, MD - 1557056

LOMBARD, AZIKIWE, MD - 1170321

PEJIC, RADE, MD - 1464431

SINGLETON, RENEE, MD - 1493040

STREIFFER, RICHARD, MD - 1908215

VALENCIA, VICTORIA, MD - 1098990

WISEMAN, PAMELA, MD - 1684660

Page 31 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



NEW ORLEANS TULANE GENERAL INTERNAL MEDICINE

(site 006)

PHY INTERNAL MEDICINE S 4 0 30 30 CLOSED PANEL275 LASALLE STREET, NEW

ORLEANS - 70112

(504)988-5030

1443719-006

COOPER, JAN, MD - 1366374

HARLAN, TIMOTHY, MD - 1011037

VENDITTO, ALEGRA, MD - 1424943

WYCHE, MICHON, MD - 1653314

NEW ORLEANS TULANE MEDICINE PEDIATRICS (site

008)

PHY PEDIATRICS S 2 0 730 2500 AGES 0 - 20200 BROADWAY, SUITE 230, NEW

ORLEANS - 70118

(504)988-9000

1443719-008



NEW ORLEANS TULANE UNIVERSITY COMMUNITY

HEALTH CENTER (site 012)


FAMILY PRACTICE

5 1 260 10500 AGES 21 - 64611 NORTH RAMPART STREET,

NEW ORLEANS - 70112

(504)988-3000

1443719-012

BAZZANO, LYDIA, MD - 1722774

CHRISTOPHER, CAROLINE, MD - 1046337

DUNN, DONISHA, MD - 1167495

FLEURY, MARKESHA, MD - 1468495

GABOR, EDITH, NP - 1072656

PRICE, EBONI, MD - 1627577

NEW ORLEANS WESTBANK PHYSICIANS ASSOCIATES PHY INTERNAL MEDICINE /

GENERAL PRACTICE

2 0 321 321 CURRENT PATIENTS

AGES 21 - 643439 KABEL DRIVE, SUITE 8, NEW

ORLEANS - 70131

(504)433-9720

1440981-001

HAQUE, MOHAMMED, MD - 1992054

SMITH, JERRY, MD - 1111244

PLAQUEMINES

BELLE CHASSE BELLE CHASSE FAMILY MEDICAL PHY FAMILY PRACTICE S 2 0 514 5000 AGES 6 - 648200 HIGHWAY 23, BELLE

CHASSE - 70037

(504)398-1100

1441392-001

CABRERA, HECTOR, MD - 1439151

GIAMBELLUCA, LAWRENCE, MD - 1319627

Page 32 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BELLE CHASSE US MED CARE, LLC PHY GENERAL PRACTICE 4 0 224 5000 AGES 21 - 647682 HIGHWAY 23, SUITE B,

BELLE CHASSE - 70037

(504)433-3363

1107719-001

ARRILLAGA - BELENDEZ, ALBERTO, MD - 1154041

CHAKRABORTI, JYOTIRMOY, MD - 1315761

GARRETT, JENNIFER, MD - 1042676

HOLMES, JR, WILLIAM, MD - 1479322

ST. BERNARD

CHALMETTE CHILDRENS INTERNATIONAL (site 004) PHY PEDIATRICS K 1 0 218 3000 AGES 0 - 17705 EAST JUDGE PEREZ DRIVE,

CHALMETTE - 70043

(504)279-5547

1449334-004

JEANSONNE, CORNEL, MD - 1347671

CHALMETTE FAMILY HEALTH CARE CLINIC PHY FAMILY PRACTICE K 1 2 170 1000 AGES 0 - 648301 WEST JUDGE PEREZ DRIVE,

SUITE 207, CHALMETTE - 70043

(504)278-1884

1150525-001

BITAR, KAMIL, MD - 1994961

LABARRE, TAMMI, NP - 1150738

LICCIARDI, PAULA, NP - 1151408

CHALMETTE LIN (site 002) EDWIN PHY PEDIATRICS K 1 0 237 2500 AGES 0 - 20221 WEST GENIE STREET,

CHALMETTE - 70043

(504)277-7634

1300195-002

CHALMETTE ST. BERNARD HEALTH CENTER PHY PEDIATRICS / FAMILY

PRACTICE

K 3 0 3211 7500 AGES 0 - 648101 WEST JUDGE PEREZ DRIVE,

CHALMETTE - 70043

(504)281-2800

1456306-001

BERTUCCI, BRYAN, MD - 1328031

JERRYTONE, JOHN, MD - 1341029

THIEN, JOHN, MD - 1966266

Page 33 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



CHALMETTE TANGPRICHA (site 002) VITHAVAS PHY PEDIATRICS K 1 0 220 2500 AGES 0 - 18221 WEST GENIE STREET,

CHALMETTE - 70043

(504)277-7634

1130788-002

Page 34 of 233


CommunityCARE Provider and Physician Summary Count by Parish

1REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

JEFFERSON-EAST BANK

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

19

12

7

3

3

2

0

0

67

16

18

4

7

0

0

7

TOTAL 46 119 14 150,000 25,479 26,069

JEFFERSON-WEST BANK

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

15

2

4

2

0

2

0

0

34

5

5

7

3

0

0

3

TOTAL 25 57 6 118,790 40,871 41,689

Page 35 of 233



1REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ORLEANS

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

23

22

9

4

2

3

0

9

76

60

45

6

5

0

0

24

TOTAL 72 216 43 213,478 61,766 63,210

PLAQUEMINES

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

1

1

0

0

0

0

0

0

3

2

0

0

0

1

TOTAL 2 6 0 10,000 2,901 3,145

Page 36 of 233



1REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ST. BERNARD

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

4

0

1

0

0

0

0

0

5

0

1

0

0

0

0

1

TOTAL 5 7 2 16,500 6,096 6,752

Page 37 of 233



REGION 1

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 61

36

9

0

7

5

10

22

36

0

0

15

19

81

182

72

TOTAL 150 405 65 508,768 137,113 140,865

Page 38 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ASCENSION

DONALDSONVILLE FAMILY MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 1269 2500 AGES 0 - 64217 RAILROAD AVENUE,

DONALDSONVILLE - 70346

(225)473-3931

1948144-001

KHANOLKAR, ROHIT, MD - 1469238

REDDY, NAGARATNA, MD - 1320251

STAFFORD, THERESA, PA - 1626597

DONALDSONVILLE ST. ELIZABETH PHYSICIANS (site 002) PHY FAMILY PRACTICE K 3 1 591 591 CURRENT PATIENTS

AGES 0 - 64214 CLINIC DRIVE,

DONALDSONVILLE - 70346

(225)473-8151

1949892-002

HIRSH, MICHEL, MD - 1096407

LANDRY, JANET, NP - 1454095

NGUYEN, PAUL, MD - 1077941

SCHEXNAYDER, GLENN, MD - 1181552

GONZALES NOWAKOWSKI BOGDAN PHY PULMONARY

DISEASES

S 1 0 254 2500 AGES 8 - 641433 EAST HIGHWAY 30,

GONZALES - 70737

(225)647-6900

1555100-001

GONZALES SOUTHERN MEDICAL ASSOCIATES PHY INTERNAL MEDICINE /

FAMILY PRACTICE

K 2 0 1252 5000 AGES 0 - 642524 SOUTH PHILIPPE AVENUE,

GONZALES - 70737

(225)644-1990

1416304-001

GBOLOO, DAVID, MD - 1562262

GBOLOO, GERTRUDE, MD - 1092223

Page 39 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



GONZALES ST. ELIZABETH PHYSICIANS (site 001) PHY PEDIATRICS K 5 3 1631 1631 CURRENT PATIENTS

AGES 0 - 642647 SOUTH ST. ELIZABETH


GONZALES - 70737(225)647-8511

1949892-001

BODIN, MICHAEL, MD - 1238341

DOOLEY, TISHA, NP - 1564877

FRAICHE, JOHN, MD - 1193810

HAIK, CHRIS, NP - 1077062

HALL, SHAWN, MD - 1970816

NARRA, RAO, MD - 1314374

NGUYEN, VINCENT, MD - 1071005

ROVIRA, MARCUS, NP - 1685364

GONZALES ST. ELIZABETH PHYSICIANS (site 003) PHY FAMILY PRACTICE /

INTERNAL MEDICINE

K 2 1 1003 1003 CURRENT PATIENTS

AGES 0 - 642647 SOUTH ST. ELIZABETH


GONZALES - 70737(225)647-8511

1949892-003

GUERIN, MADELEINE, MD - 1988821

PETITE, TRACY, NP - 1004529

ZITMAN, DAWN, MD - 1465607

GONZALES ST. ELIZABETH PHYSICIANS (site 005) PHY FAMILY PRACTICE /

PEDIATRICS


AGES 0 - 641702 NORTH BURNSIDE AVENUE,

SUITE A, GONZALES - 70737

(225)647-8319

1949892-005

ABRAMSON, STEVEN, MD - 1092576

AGUILLARD, JR., P. CARY, MD - 1984329

GONZALES ST. ELIZABETH PHYSICIANS (site 007) PHY PEDIATRICS S 1 0 1165 1165 CURRENT PATIENTS

AGES 0 - 14721 EAST HIGHWAY 30,

GONZALES - 70737

(225)644-7337

1949892-007

MATHEW, LEYAMMA, MD - 1310344

GONZALES TWUM - ANTWI YAW PHY INTERNAL MEDICINE K 1 0 998 2500 AGES 6 - 64723 EAST HIGHWAY 30,

GONZALES - 70737

(225)644-5393

1922102-001

Page 40 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



GONZALES VAZQUEZ - BORRERO CARLOS PHY INTERNAL MEDICINE B 1 0 451 2500 AGES 12 - 641937 SOUTH BURNSIDE,

GONZALES - 70737

(225)647-1947

1495859-001

GONZALES WILLIAMS JERRY PHY INTERNAL MEDICINE 1 0 247 2500 AGES 21 - 64317 WEST ASCENSION,

GONZALES - 70737

(225)647-9297

1347353-001

PRAIRIEVILLE MAGNOLIA PEDIATRICS PHY PEDIATRICS K 2 0 318 318 CURRENT PATIENTS

AGES 0 - 2017503 OLD JEFFERSON

HIGHWAY, PRAIRIEVILLE - 70769

(225)744-4484

1449385-001

CLARK, SAMANTHA, MD - 1575097

WEST, ASHLI, MD - 1576905

PRAIRIEVILLE ST. ELIZABETH PHYSICIANS (site 004) PHY MULTI - SPECIALTY

CLINIC


AGES 1 - 6417609 OLD JEFFERSON

HIGHWAY, SUITE D,

PRAIRIEVILLE - 70769(225)677-9595

1949892-004

ABBOTT, KIMBERLY, NP - 1583294

ABRAMSON, STEVEN, MD - 1092576

BARRIENT, DAWN, MD - 1489042

BEEMAN, CHAD, NP - 1141828

BUSENLENER, KELLY, MD - 1647276

D'ANTONI, JR, JAMES, MD - 1490032

HILL, BUNNIE, MD - 1530093

PERKINS, THOMAS, MD - 1950424

PHILIPPE, KAY, MD - 1492612

SAUNDERS, JEAN, MD - 1545422

PRAIRIEVILLE ST. ELIZABETH PHYSICIANS (site 008) PHY MULTI - SPECIALTY

CLINIC


AGES 0 - 6414225 HIGHWAY 73,

PRAIRIEVILLE - 70769

(225)673-3033

1949892-008

KINCHEN, MARY, NP - 1357006

KIRBY, DIANE, MD - 1484709

KNAPP, JOHN, MD - 1902136

Page 41 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



EAST BATON ROUGE

BAKER DEJOHN MICHAEL PHY INTERNAL MEDICINE 1 0 55 55 CURRENT PATIENTS

AGES 21 - 644444 GROOM ROAD, BAKER -

70714

(225)774-9134

1305928-002

BAKER INTERNAL MEDICINE & PEDIATRIC

CLINIC


PEDIATRICS

K 5 1 2074 2500 LIMITED PANEL; AGES 0

- 166516 EAST MYRTLE STREET,

BAKER - 70714

(225)774-7320

1443093-001

DELAUNE, ALICE POWELL, PA - 1626805

FOLSE, T'LANE, MD - 1695793

GIARRUSSO, BRAD, MD - 1065421

RHODES, KENT, MD - 1911496

SMITH, BRADFORD, MD - 1555843

SPEEGS, STEPHEN, MD - 1349364

BAKER MANALAC RODOLFO PHY FAMILY PRACTICE 1 0 23 2500 AGES 40 - 643034 RAY WEILAND DRIVE,

BAKER - 70714

(225)775-8500

1353019-001

BAKER MOUTON MARK PHY INTERNAL MEDICINE 1 0 97 2500 AGES 21 - 6412902 PLANK ROAD, BAKER -

70714

(225)774-7111

1090484-001

BAKER THOMPSON E. GENE PHY INTERNAL MEDICINE 1 0 30 30 CURRENT PATIENTS

AGES 21 - 6412902 PLANK ROAD, BAKER -

70714

(225)774-3883

1312916-001

Page 42 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BATON ROUGE ACADIAN MEDICAL CLINIC PHY GENERAL PRACTICE S 1 0 688 2500 AGES 2 - 64412 NORTH ACADIAN THRUWAY,

BATON ROUGE - 70806

(225)338-1145

1440493-001

DIGGS, JOSEPH, MD - 1341436

BATON ROUGE BANKS RAYNANDO PHY FAMILY PRACTICE S 1 0 992 2500 AGES 5 - 643905 COVENTION STREET,

BATON ROUGE - 70806

(225)387-7858

1924245-001

BATON ROUGE BATON ROUGE PEDIATRIC CLINIC PHY PEDIATRICS K 1 1 2356 2356 CURRENT PATIENTS

AGES 0 - 207750 GREENWELL SPRINGS,

BATON ROUGE - 70814

(225)928-9550

1447650-001

BILETNIKOFF, BARBARA, NP - 1118125

SLAUGHTER, ROSALYN, MD - 1907707

BATON ROUGE BATON ROUGE PRIMARY CARE

COLLABORATIVE (site 001)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 1 668 3000 AGES 0 - 641414 FAIRCHILD STREET, BATON

ROUGE - 70807

(225)774-1120

1447439-001

DIGGS, JOSEPH, MD - 1341436

EVANS, MARGARET, NP - 1000400

MADISON, III, EDWARD, MD - 1480631

BATON ROUGE BATON ROUGE PRIMARY CARE

COLLABORATIVE (site 002)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

S 0 1 153 1000 AGES 0 - 64220 ST. VINCENT DEPAUL PLACE,

BATON ROUGE - 70802

(225)343-9086

1447439-002

EVANS, MARGARET, NP - 1000400

BATON ROUGE BOSTICK LESLIE PHY PEDIATRICS K 1 0 509 509 CURRENT PATIENTS &

NEWBORNS AGES 0 - 118595 PICARDY AVENUE, SUITE

200, BATON ROUGE - 70808

(225)767-5520

1557196-001

Page 43 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BATON ROUGE CAPITOL CITY FAMILY HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 3 1 2287 3000 AGES 0 - 643140 FLORIDA BOULEVARD,

BATON ROUGE - 70806

(225)650-2000

1948055-001

CAMPBELL, JR, WALTER, MD - 1361691

DAO, XUONG, MD - 1921556

LANGIE, JACQUELINE, MD - 1311553

WEBBER, JOSEPH, NP - 1543144

BATON ROUGE CHALASANI LALITHA PHY INTERNAL MEDICINE 1 0 75 2500 AGES 21 - 643401 NORTH BOULEVARD, SUITE


(225)381-2789

1544507-001

BATON ROUGE CHEVALIER TIFFANNY PHY PEDIATRICS K 1 0 1411 1411 OPEN AGES 0 - 1

MTH;CURRENT PTS

AGES 2 MTHS -17YRS

8786 GOODWOOD BOULEVARD,

SUITE 105, BATON ROUGE -

70806(225)927-7480

1189685-001

BATON ROUGE CHILD HEALTH AMERICA PHYSICIAN

GROUP


GENERAL PRACTICE

K 2 0 1770 2500 AGES 0 - 203955 GOVERNMENT STREET,

SUITE 1, BATON ROUGE - 70806

(225)343-1565

1442852-001

NGUYEN, ANH, MD - 1934097

NGUYEN, XUONG, MD - 1329746

BATON ROUGE CURRY JANE PHY PEDIATRICS K 1 0 315 315 OPEN AGES BIRTH - 6

MNTHS;CURR PTS AGES

7M - 17YR

8235 YMCA PLAZA DRIVE, SUITE


(225)766-1109

1994731-001

BATON ROUGE DAO XUONG PHY INTERNAL MEDICINE S 1 0 773 2500 AGES 0 - 6412389 FLORIDA BOULEVARD,

BATON ROUGE - 70815

(225)272-8222

1921556-001

Page 44 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BATON ROUGE DESPINASSE - II BRIAN PHY PEDIATRICS K 1 0 1220 1220 OPEN AGES 0 - 4M; CURR

PTS & SIBLINGS AGES 5M

-20Y

8894 AIRLINE HIGHWAY, SUITE Q,

BATON ROUGE - 70815

(225)922-8377

1490903-001

BATON ROUGE DIAL DANIEL PHY INTERNAL MEDICINE 1 0 20 20 CURRENT PATIENTS

AGES 21 - 6410880 JOOR ROAD, BATON

ROUGE - 70818

(225)262-7710

1663387-001

BATON ROUGE DIXON HENRY PHY INTERNAL MEDICINE 1 0 524 2500 AGES 21 - 644750 NORTH BOULEVARD,

BATON ROUGE - 70806

(225)218-0703

1161683-001

BATON ROUGE FAMILY HEALTH CENTER PHY FAMILY PRACTICE K 6 0 2393 2500 MAX CAPACITY

EXCEEDED; LIMITED

PANEL; AGES 0 - 64

3801 NORTH BOULEVARD,

BATON ROUGE - 70806

(225)381-6620

1943053-001

ANDERSON, DEREK, MD - 1996254

CHASAK, ROBERT, MD - 1369781

GENO, CHARLES, MD - 1663034

HILL, YOLANDA, MD - 1482765

SCHULTE, BRIAN, MD - 1530514

SHAW JR, VINCENT, MD - 1058823

BATON ROUGE FELDMAN ROBERT PHY PEDIATRICS S 1 0 2341 2500 AGES 0 - 204245 WINBOURNE AVENUE,

BATON ROUGE - 70805

(225)357-2248

1047813-001

BATON ROUGE HALL COREY PHY FAMILY PRACTICE 1 0 594 2500 AGES 21 - 647932 SUMMA AVENUE, SUITE B 2,

BATON ROUGE - 70809

(225)766-1616

1140651-001

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BATON ROUGE HINES III JAMES PHY FAMILY PRACTICE S 1 0 1140 2500 AGES 0 - 642153 NORTH FOSTER DRIVE,

BATON ROUGE - 70806

(225)356-9775

1195502-001

BATON ROUGE HOWARD MICHAEL PHY GENERAL PRACTICE 1 0 630 2500 AGES 21 - 643525 RILEY STREET, BATON

ROUGE - 70805

(225)356-2004

1533904-001

BATON ROUGE IBEKWE RUBY PHY FAMILY PRACTICE S 1 0 861 2500 AGES 2 MONTHS - 64

YEARS3923 CONVENTION STREET,

BATON ROUGE - 70806

(225)381-6474

1988839-001

BATON ROUGE JONES STACY PHY FAMILY PRACTICE S 1 0 61 2500 AGES 0 - 643905 CONVENTION STREET,

BATON ROUGE - 70806

(225)387-7858

1091782-001

BATON ROUGE LPCP FAMILY PRACTICE ASSOCIATES

(site 002)

PHY FAMILY PRACTICE S 4 0 32 32 CLOSED PANEL12525 PERKINS ROAD, BATON

ROUGE - 70810

(225)765-4256

1941913-002

BARBER, GERALD, MD - 1352977

BRIGNAC, DONALD, MD - 1350257

CHAMBERLAIN, MATTHEW, MD - 1107361

LEE, YUHEN, MD - 1042773

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BATON ROUGE LPCP INTERNAL MEDICINE OF BATON

ROUGE (site 001)

PHY INTERNAL MEDICINE S 8 0 94 94 CURRENT PATIENTS

AGES 18 - 647777 HENNESSY BOULEVARD,


70808(225)765-8829

1941913-001

BARFIELD, LAUREN, MD - 1090395

BLAIZE, III, LEO, MD - 1327891

GREMILLION, BRIAN, MD - 1366218

HALLIBURTON, CHARLES, MD - 1656500

JOHNSON, JERI, MD - 1187771

MEEK, BRADLEY, MD - 1554294

PEARCE, KATHERINE, MD - 1540188

REYES, EFRAIN, MD - 1326836

BATON ROUGE LPCP LAKE PEDIATRICS @ O'NEAL (site

033)

PHY PEDIATRICS K 3 0 2059 2059 OPEN BIRTH - 2 MONTH;

CURR PTS & SIBLINGS

2M - 15Y

2380 O'NEAL LANE, SUITE A,

BATON ROUGE - 70816

(225)214-3714

1941913-033

GRIER, MANDY, MD - 1628271

RYAN, TARA, MD - 1159123

THOMAS, JOSEPH, MD - 1306584

BATON ROUGE LPCP PEDIATRIC MEDICAL CENTER

(site 009)

PHY PEDIATRICS K 9 0 2182 2182 CURRENT PATIENTS

ONLY AGES 0 - 209191 BLUEBONNET BOULEVARD,

BATON ROUGE - 70810

(225)769-2003

1941913-009

DANIEL, CHARLES, MD - 1315541

FLECHAS, MICHELLE, MD - 1491152

FRANZ, SANDRA, MD - 1434434

HARRIS, JENNIFER, MD - 1464121

HART, SUZANNE, MD - 1499943

HEFLIN, THOMAS, MD - 1122157

HUTCHINSON, BRETT, MD - 1074926

LUCAS, ASHLEY, MD - 1480568

REED, SANDY, MD - 1492761

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BATON ROUGE LPCP PEDIATRICS AT GOODWOOD (site

027)

PHY PEDIATRICS K 6 3 10182 10182 AGES 0 - 5; CURRENT

PTS & SIBLINGS AGES 6 -

18



70808(225)765-5633

1941913-027

BREAUX, MICHELLE, NP - 1015695

COLLINSWORTH, JAY, MD - 1336262

CRAWFORD, AMANDA, NP - 1468789

DENHAM, AMBER, MD - 1174157

GIORLANDO, PAUL, MD - 19276919

JAYASANKARAN, M P, MD - 1547646

MCCORMICK, MELISSA, MD - 1012343

SHRIVER, PAM, NP - 1995380

TALBOT, AMANDA, MD - 1170771

BATON ROUGE LPCP PRIMARY CARE OF SOUTH

BATON ROUGE

PHY PEDIATRICS K 1 0 25 25 OPEN NEW PTS 0 - 2M,

CURR PTS & SIBLINGS

3M - 17Y

18169 EAST PETROLEUM DRIVE,

BUILDING 9, BATON ROUGE -

70809(225)765-5247

1941913-025

RYAN, TARA, MD - 1159123

BATON ROUGE LPCP SENIOR CARE OF INTERNAL

MEDICINE OF BR (site 028)

PHY INTERNAL MEDICINE 4 4 3 3 CLOSED PANEL5339 DIDESE, BATON ROUGE -

70808

(225)765-3076

1941913-028

BAIG, MOHAMMED, MD - 1628930

DAVID, BYRON, NP - 1022616

GAHAN, W. PATRICK, MD - 1196550

MIRE, JOYCE, NP - 1177199

NELSON, SUSAN, MD - 1991597

PENNINGTON, LYNN, NP - 1438855

SANDERS, TERRY, PA - 1009733

TIPTON, EDMOND, MD - 1175315

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BATON ROUGE LPCP SOUTHEAST PEDIATRICS (site

012)

PHY PEDIATRICS K 5 1 3332 3332 OPEN AGES 0 - 2;

CURRENT PTS &

SIBLINGS AGES 3 -20



70806(225)925-9797

1941913-012

ALLIGOOD, KELLI, NP - 1527467

CANNIZZARO, CHRISTINA, MD - 1885142

FUNES, CHRISTOPHER, MD - 1429490

MARTIN, JAMEL, MD - 1570176

RAO, MURLI, MD - 1044105


BATON ROUGE LSUHN BILLING LLC - EKL FAMILY (site

005)

PHY FAMILY PRACTICE S 7 5 836 15000 AGES 18 - 641401 NORTH FOSTER DRIVE,

BATON ROUGE - 70806

(225)987-9000

1038270-005

ALLEMAN, MONICA, NP - 1323985

FECHETE, MARTA, MD - 1479233

GREEN, SAMAKI, NP - 1347311

GRIEBROK - ASSE, JULE, MD - 1489611

HECK, MADELEINE, MD - 1348457

HOWE, JOHN, MD - 1196002

JACKSON, ANDREA, NP - 1311901

PERKINS, SHEILA, NP - 1184144

POURCIAU, CATHERINE, NP - 1543713

STUART, MICHAEL, MD - 1366137

WERNER, SHARON, MD - 1381977

ZHENG, YIHONG, MD - 1493554

BATON ROUGE LSUHN BILLING LLC - EKL PEDIATRIC

(site 004)

PHY PEDIATRICS K 7 1 4243 12500 AGES 0 - 181401 NORTH FOSTER DRIVE,

BATON ROUGE - 70806

(225)987-9000

1038270-004

ARMSTRONG, JADA, MD - 1987883

GORDON, STEWART, MD - 1969214

GRANT, SANDRA, MD - 1343838


LUKE, LEELA, MD - 1328243

ROSCOE, NARKITA, NP - 1316032

VENTERS, CHARMAINE, MD - 1974269

WOODARD, TRACI, MD - 1044130

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BATON ROUGE LSUHN EKL - LEO BUTLER (site 007) PHY INTERNAL MEDICINE S 1 1 270 3000 AGES 18 - 64950 EAST WASHINGTON, BATON

ROUGE - 70802

(225)358-2520

1038270-007

HOLLAND, CATHERINE, NP - 1345652

HUDSON, JANICE, MD - 1031046

BATON ROUGE LSUHN EKL - MEDICINE (site 006) PHY INTERNAL MEDICINE S 10 0 680 5000 AGES 18 - 645825 AIRLINE HIGHWAY, BATON

ROUGE - 70806

(225)358-1110

1038270-006

CANNATELLA, MARLA, MD - 1938173

HECK, MADELIENE, MD - 1348457

JOHNSON, ANGELA, MD - 1421146

JOHNSON, JOLENE, MD - 1399523

KARAM, GEORGE, MD - 1331414

LAURET, DEAN, MD - 1057894

NEUMANN, D EDWARD, MD - 1399248

RHODES, KENT, MD - 1911496

THIBODEAUX, JR., ROBERT, MD - 1693324

THOMPSON, E.GENE, MD - 1312916

BATON ROUGE LSUHN EKL - NORTH BATON ROUGE

(site 008)

PHY FAMILY PRACTICE S 3 0 345 7500 AGES 18 - 642013 CENTRAL ROAD, BATON

ROUGE - 70807

(225)771-6205

1038270-008

FECHETE, MARTA, MD - 1479233


ZHENG, YIHONG, MD - 1493554

BATON ROUGE MAYO TAMIKA PHY FAMILY PRACTICE S 1 0 938 2500 AGES 1 - 643401 NORTH BOULEVARD, SUITE


(225)381-2712

1576565-001

BATON ROUGE MAYS STAN PHY FAMILY PRACTICE S 1 0 982 2500 AGES 0 - 644242 GUS YOUNG AVENUE,

BATON ROUGE - 70802

(225)926-2258

1362948-001

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BATON ROUGE MURRILL MELVIN PHY PEDIATRICS S 1 0 2194 2500 AGES 0 - 204560 NORTH BOULEVARD, SUITE


(225)928-0695

1305561-001

BATON ROUGE OLD HAMMOND PEDIATRICS PHY PEDIATRICS K 4 2 1925 1925 OPEN AGES 0 - 12; CURR

PTS & SIBLINGS AGES 13

- 18

11548 OLD HAMMOND HIGHWAY,

BATON ROUGE - 70815

(225)273-5995

1025208-001

ASH, MONICA, NP - 1368261

GELPI, GREGORY, MD - 1381781

KELLEHER, STEPHANIE, MD - 1570214

MAYO, BRIANA, NP - 1795470

SCHWARTZENBURG, GEORGE, MD - 1025208

VICK, DAWN, MD - 1539147

BATON ROUGE OPTIMAL HEALTH OUT - PATIENT

CLINIC

PHY INTERNAL MEDICINE K 1 1 745 2500 AGES 0 - 647240 RENOIR, BATON ROUGE -

70806

(225)932-9150

1447579-001

FRANCIS, ADEBOYE, MD - 1558494

WADE, SHIRLEY, NP - 1141372

BATON ROUGE OUR LADY OF THE LAKE

NEIGHBORHOOD CLINIC

PHY PEDIATRICS / FAMILY

PRACTICE

K 1 2 1731 3500 AGES 0 - 649422 SCOTLAND AVENUE, BATON

ROUGE - 70807

(225)774-1822

1949311-001

KANTROW, CHARLES, MD - 1117692

KUBRICHT, DOROTHA, NP - 1559270

ROUGEOU, CORINNE, NP - 1551384

BATON ROUGE PEDIATRIC HEALTH ASSOCIATES PHY PEDIATRICS K 1 1 1559 2500 AGES 0 - 18624 CHEVELLE DRIVE, BATON

ROUGE - 70806

(225)925-2055

1449245-001

HEDGEMON, HELEN, MD - 1354368

RANDALL, ZELMA, NP - 1995827

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BATON ROUGE PEDICONS / KIDMED NORTH PHY PEDIATRICS K 1 2 3232 3500 AGES 0 - 205151 PLANK ROAD, BATON

ROUGE - 70805

(225)356-2006

1947172-001

LEONARD - HUGHES, LATOYA, NP - 1304450

LOUQUE, JENNIFER, NP - 1310387

MAHADEVAN, PANKAJAM, MD - 1537691

BATON ROUGE PEDICONS / KIDMED SOUTH PHY PEDIATRICS K 1 1 2525 500 MAX CAPACITY

EXCEEDED; AGES 0 - 207216 PICARDY AVENUE, SUITE C,

BATON ROUGE - 70820

(225)767-3800

1947172-002

BOKUN, REBECCA, NP - 1475866

CONRAD, REGINA, MD - 1794023

BATON ROUGE PHAM LUAN PHY FAMILY PRACTICE K 1 0 917 917 NEW PTS AGES 0 - 20;

CURRENT PTS AGES 21 -

64

9936 - B FLORIDA BOULEVARD,

BATON ROUGE - 70815

(225)927-8772

1988049-001

BATON ROUGE PRIMARY CARE GROUP, THE (site 004) PHY FAMILY PRACTICE S 3 0 540 7500 AGES 0 - 643401 NORTH BOULEVARD, SUITE


(225)381-2727

1443328-004

BATIE, DONNIE, MD - 1317268

VINAYAGAN, VASANTHI, MD - 1574228

WAHID, DARAKHSHAN, MD - 1681971

BATON ROUGE ROBERTS JONATHAN PHY INTERNAL MEDICINE 1 0 309 2500 AGES 21 - 648333 GOODWOOD BOULEVARD,

BATON ROUGE - 70806

(225)952-9460

1930628-001

BATON ROUGE RONALD ANDREWS MD PHY GENERAL PRACTICE K 1 0 479 479 CURRENT PATIENTS AND

SIBLINGS AGES 0 - 648894 AIRLINE HIGHWAY, SUITE Q,

BATON ROUGE - 70815

(225)922-8377

1036897-001

ANDREWS, RONALD, MD - 1490181

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BATON ROUGE SEFA AKWASI PHY INTERNAL MEDICINE S 1 0 856 1000 LIMITED PANEL; AGES 14

- 644560 NORTH BOULEVARD, SUITE


(225)925-2331

1651036-001

BATON ROUGE SMITH CHRISTINE PHY FAMILY PRACTICE S 1 0 218 218 CLOSED PANEL11281 OLD HAMMOND HIGHWAY,

BUILDING B, BATON ROUGE -

70815(225)275-4656

1666807-001

BATON ROUGE STANOCOLA MEDICAL CENTER /

INTERNAL MEDICINE (site 003)

PHY INTERNAL MEDICINE 3 1 172 175 LIMITED PANEL; AGES 21

- 6416777 MEDICAL CENTER DRIVE,


70816(225)926-7200

1943118-003

BARAI, LALIT, MD - 1321648

GUARISCO, MICHAEL, MD - 1381993

GUPTA, ALOK, MD - 1977781

PINO, LANNIE, NP - 1460508


PEDIATRICS DEPT (site 001)

PHY PEDIATRICS K 2 1 1663 2500 AGES 0 - 2016777 MEDICAL CENTER DRIVE,


70816(225)926-7200

1943118-001

GIRGIS, SALWA, MD - 1361291

LEMELLE, TRACY, MD - 1044041



PRIMARY CARE DEPT (site 002)

PHY FAMILY PRACTICE 4 1 220 225 LIMITED PANEL; AGES 21

- 6416777 MEDICAL CENTER DRIVE,


70816(225)926-7200

1943118-002

GIRGIS, SALWA, MD - 1361291

GUARISCO, MICHAEL, MD - 1381993

MORENO, MARIO, MD - 1330752


STRYJEWSKA, BARBARA, MD - 1660795

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BATON ROUGE THOMAS VERONICA PHY PEDIATRICS K 1 0 1144 1144 NEWBORNS AGES 0 - 3M;

CURR PTS& SIBLINGS 4M

- 15Y



70806(225)810-4785

1378496-001

BATON ROUGE URGENT CARE & FAMILY MEDICINE PHY GENERAL PRACTICE /

FAMILY PRACTICE

B 1 2 1271 2500 AGES 0 - 641962 O'NEAL LANE, SUITE H - 1,

BATON ROUGE - 70816

(225)755-0095

1449105-001

AUBIN, MARGARET, NP - 1165000

ROPPOLO, JOHN, PA - 1581721

WAHID, SAIYID, MD - 1980561

BATON ROUGE WILLIAMS JACQUELINE PHY PEDIATRICS K 1 0 991 991 CURRENT PATIENTS

AGES 0 - 157516 PICARDY AVENUE, SUITE B,

BATON ROUGE - 70808

(225)765-7144

1337358-001

ZACHARY KHELGHATI AMRULLAH PHY PEDIATRICS S 1 0 1913 2500 AGES 0 - 209305 MAIN STREET, SUITE D,

ZACHARY - 70791

(225)654-0300

1361038-001

ZACHARY LPCP PRIMARY CARE OF ZACHARY PHY PEDIATRICS K 1 0 210 210 OPEN AGES 0 - 10;


20

4727 WEST PARK DRIVE, SUITE

B, ZACHARY - 70791

(225)654-6140

1941913-026


ZACHARY MEDINA JUAN PHY INTERNAL MEDICINE S 1 0 36 36 CURRENT PATIENTS

AGES 16 - 644727 WEST PARK DRIVE, SUITE

A, ZACHARY - 70791

(225)658-8111

1977152-001

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ZACHARY MONROE - WILKES GRETA PHY FAMILY PRACTICE S 1 0 327 2500 AGES 0 - 646110 MAIN STREET, ZACHARY -

70797

(225)658-2036

1532274-001

ZACHARY SANTOS - MATA ELENITA PHY PEDIATRICS K 1 0 452 452 CURRENT PATIENTS,

NEWBORNS & SIBLINGS

AGES 0 - 16

4851 WEST PARK DRIVE, SUITE

A, ZACHARY - 70791

(225)658-7636

1372617-001

ZACHARY ZACHARY FAMILY PRACTICE PHY GENERAL PRACTICE /

FAMILY PRACTICE

S 4 0 109 109 CURRENT PATIENTS

AGES 1 - 642335 CHURCH STREET, SUITE E,

ZACHARY - 70791

(225)654-3607

1445126-001

AMACKER, MICHAEL, MD - 1193330

COSSE, MICHELLE, MD - 1430935

ELKINS, REAGAN, MD - 1053112

GRAVOIS, WAYNE, MD - 1338915

EAST FELICIANA

CLINTON CLINTON HIGH HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 2 N/A 1000 AGES 0 - 6410410 PLANK ROAD, CLINTON -

70722

(225)683-1340

1329401-001

BLACKMON, BETTIE, NP - 1114367

HUNT, GINGER, NP - 1653047

CLINTON CLINTON LOWER HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 2 N/A 1000 AGES 0 - 6410701 REILEY STREET, CLINTON -

70722

(225)683-1350

1188522-001

COUNTS, MELODY, MD - 1568961

GILLIAM, DARIE, NP - 1534935


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CLINTON CLINTON MIDDLE HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 5 33 1000 AGES 0 - 6412126 LIBERTY STREET, CLINTON

- 70722

(225)683-8877

1450294-001



HORNBOSTEL - BAKER, JUDY, NP - 1455016



CLINTON DEJOHN MICHAEL PHY INTERNAL MEDICINE S 1 0 47 47 CURRENT PATIENTS

AGES 12 - 6411315 LIBERTY HIGHWAY,

CLINTON - 70722

(225)683-3358

1305928-001

CLINTON KAKARALA VENU PHY INTERNAL MEDICINE K 1 0 124 2500 AGES 0 - 6411333 CHURCH STREET,

CLINTON - 70722

(225)683-3901

1569097-001

CLINTON OPTIMAL HEALTH OUT- PATIENT CLINIC PHY INTERNAL MEDICINE K 1 1 5 3000 AGES 0 - 649508 HIGHWAY 67, SUITE B,

CLINTON - 70722

(225)683-4264

1447579-002

FRANCIS, ADEBOYE, MD - 1558494

WADE, SHIRLEY, NP - 1141372

CLINTON RATHBONE CLINIC (site 001) PHY GENERAL PRACTICE K 1 1 489 3000 AGES 0 - 6411323 CHURCH STREET,

CLINTON - 70722

(225)683-3377

1949167-001

BRINGEDAHL, KARLA, NP - 1542270

RATHBONE, RICHARD, MD - 1336777

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CLINTON RKM PRIMARY CARE FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 6 998 3000 AGES 0 - 6411990 JACKSON STREET,

CLINTON - 70722

(225)683-5292

1450278-001


CONNELL, KRISTA, NP - 1409723





JACKSON JACKSON COMPLEX HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 6 2 1000 AGES 0 - 643501 HIGHWAY 10, JACKSON -

70748

(225)634-7145

1448389-001


CONNELL, KRISTA, NP - 1409723





JACKSON NWABUEZE NNAMDI PHY GENERAL PRACTICE K 1 0 754 2500 AGES 0 - 643050 CHARLES DRIVE, JACKSON

- 70748

(225)634-3517

1552232-001

SLAUGHTER SLAUGHTER HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 1 2 1000 AGES 0 - 643170 CHURCH STREET,

SLAUGHTER - 70777

(225)654-2021

1188565-001

COCKERHAM, YOLANDA, NP - 1355411


IBERVILLE

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GROSSE TETE HEALTH CARE FIRST MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 0 3 82 1000 AGES 0 - 6418015 WILLOW STREET, GROSSE

TETE - 70740

(225)648-3433

1070378-001

ATKINS - LUSTER, KOURTNI, NP - 1454711

ATKINS - LUSTER, KOURTNI, NP - 1454711

LEONARD - HUGHES, LATOYA, NP - 1304450

MARINGOUIN MARINGOUIN MEDICAL CENTER, LLC PHY FAMILY PRACTICE K 2 4 204 500 AGES 0 - 6477695 WAGLEY ROAD,

MARINGOUIN - 70757

(225)625-2313

1029751-001

BERTRAND, KELLIE, NP - 1174882

DOUCET, DONALD, MD - 1345491

ELLIOTT, JR, LEONE, MD - 1568970

NEWTON, DEDRA, NP - 1477761

RICHARD, ROSALIE, NP - 1143324

SMITH - PERRAULT, STACEY, NP - 1478831

PLAQUEMINE BROWN ANDREA PHY GENERAL PRACTICE K 1 0 455 2500 AGES 0 - 3523845 CHURCH STREET,

PLAQUEMINE - 70764

(225)687-2828

1490474-001

PLAQUEMINE FAMILY FIRST MEDICAL CLINIC PHY FAMILY PRACTICE K 1 0 161 161 CURRENT PATIENTS

AGES 0 - 6425073 HIGHWAY 1 SOUTH,

PLAQUEMINE - 70764

(225)687-1772

1445622-001

EDWARDS, ANTONIO, MD - 1534358

PLAQUEMINE FITCH ANDRIETTE PHY INTERNAL MEDICINE K 1 0 1259 2500 AGES 0 - 6458155 CHINN STREET, SUITE B,

PLAQUEMINE - 70764

(225)687-8838

1484121-001

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PLAQUEMINE GARRISON - NORTH NEFRETITI PHY PEDIATRICS K 1 0 291 2500 AGES 0 - 6458155 CHINN STREET, SUITE B,

PLAQUEMINE - 70764

(225)687-8838

1042943-001

PLAQUEMINE LPCP ASSOCIATES IN INTERNAL

MEDICINE OF PLAQUEMINE

PHY INTERNAL MEDICINE K 1 0 329 329 CURRENT PATIENTS

AGES 0 - 6459325 RIVER WEST DRIVE, SUITE

C, PLAQUEMINE - 70764

(225)687-9700

1941913-043

DEAN, KEVIN, MD - 1052485

PLAQUEMINE PEDIATRIC ASSOCIATES PHY PEDIATRICS K 2 0 5558 5000 MAX CAPACITY

EXCEEDED; AGES 0 - 1859325 RIVERWEST DRIVE, SUITE

D, PLAQUEMINE - 70764

(225)687-3055

1942049-001

ELKINS, KATHRYN, MD - 1378712

QUINN, MICHAEL, MD - 1349348

PLAQUEMINE PRIME HEALTH LLC RHC RURAL HEALTH

CLINIC

K 4 2 552 6000 AGES 0 - 6459295 RIVERWEST DRIVE, SUITE

C, PLAQUEMINE - 70764

(225)687-2001

1440051-001

GAUTHREAUX, DANA, PA - 1456527

JACKSON, JR., PAUL, MD - 1979953

LEE, LUKE, MD - 1977721

MONDELLO, KELLY, PA - 1529095

SCAVELLA, ARNETTE, MD - 1075027

SIMON, LYNN, MD - 1145645

PLAQUEMINE REDDY FAMILY MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 270 1000 AGES 0 - 6458725 BELLEVIEW, SUITE A-5,

PLAQUEMINE - 70764

(225)687-6200

1949809-001



STAFFORD, TERESA, PA - 1626597

Page 59 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ST. GABRIEL ST. GABRIEL HEALTH CLINIC, INC. FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

B 2 0 228 2500 AGES 0 - 645720 MONTICELLO STREET, ST.

GABRIEL - 70776

(225)642-9676

1944114-001

MADISON, III, EDWARD, MD - 1480631

ROBERTS, JONATHAN, MD - 1930628

WHITE CASTLE REDDY FAMILY MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 278 1000 AGES 0 - 6432985 BOWIE STREET, WHITE

CASTLE - 70788

(225)545-3631

1949248-001




POINTE COUPEE

INNIS INNIS COMMUNITY HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 1 459 5000 AGES 0 - 646450 LA HIGHWAY 1, INNIS -

70747

(225)492-3775

1441961-001

AUBIN, MARGARET, NP - 1165000

CARTER, II, LAWRENCE, MD - 1571156

WILLIAMS, LEON, MD - 1071056

LIVONIA LIVONIA COMMUNITY HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 1 328 3000 AGES 0 - 643041 FORDOCHE ROAD, LIVONIA

- 70755

(225)637-3535

1450618-001

BREAUX, JERYL, MD - 1049450

SCROGGS, MARGARET, NP - 1545686

NEW ROADS BRIAN LEBLANC, MD RHC RURAL HEALTH

CLINIC

K 1 0 887 887 NEW PTS AGES 0 - 17;

CURRENT PATIENTS

AGES 18 - 64

160 HOSPITAL ROAD, NEW

ROADS - 70760

(225)638-4686

1447536-001

LEBLANC, BRIAN, MD - 1665266

Page 60 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



NEW ROADS CARL MCLEMORE RHC RURAL HEALTH

CLINIC

K 1 0 684 684 NEW PTS AGES 0 - 17;

CURRENT PATIENTS

AGES 18 - 64

230 ROBERTS DRIVE SUITE B,

NEW ROADS - 70760

(225)638-8661

1447510-001

MCLEMORE, JR., CARL, MD - 1184659

NEW ROADS CHRISTOPHER JAMES PHY FAMILY PRACTICE S 1 0 157 2500 AGES 0 - 64230 ROBERTS DRIVE, SUITE F,

NEW ROADS - 70760

(225)638-9078

1059684-001

NEW ROADS DONALD DOUCET, MD & ASSOCIATES,

LLC

PHY INTERNAL MEDICINE S 2 0 13 13 CLOSED PANEL230 ROBERTS DRIVE, SUITE I,

NEW ROADS - 70760

(225)638-4585

1948268-001

DOUCET, DONALD, MD - 1345491

PICARD, JASON, MD - 1554693

NEW ROADS LOUIS MONTELARO, MD RHC RURAL HEALTH

CLINIC

K 1 0 374 374 CURRENT PATIENTS &

SIBLINGS AGES 0 - 17230 ROBERTS DRIVE SUITE E,

NEW ROADS - 70760

(225)638-3781

1447528-001

MONTELARO, LOUIS, MD - 1109941

NEW ROADS LPCP DR. CAROL SMOTHERS PHY FAMILY PRACTICE K 1 0 530 2500 AGES 0 - 64230 ROBERTS DRIVE, SUITE D,

NEW ROADS - 70760

(225)638-8911

1941913-039

SMOTHERS, CAROL, MD - 1670880

NEW ROADS PAUL RACHAL, MD RHC RURAL HEALTH

CLINIC

K 1 0 488 488 NEWBORNS & SIBLINGS

OF CURRENT PTS AGES

0 - 17

230 ROBERTS DRIVE, NEW

ROADS - 70760

(225)638-7033

1447501-001

RACHAL, PAUL, MD - 1360171

WEST BATON ROUGE

Page 61 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BRUSLY HIGGINS BRIAN PHY FAMILY PRACTICE K 1 0 602 2500 AGES 0 - 64402 NORTH VAUGHN STREET,

BRUSLY - 70719

(225)749-2645

1574180-001

PORT ALLEN REDDY SANTHOSH PHY INTERNAL MEDICINE /

GENERAL PRACTICE

B 1 0 956 2500 AGES 0 - 64970 NORTH ALEXANDER, PORT

ALLEN - 70767

(225)383-6363

1321851-001

PORT ALLEN WBR PRIMARY CARE FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 1 146 1000 AGES 0 - 64751 COURT STREET, PORT

ALLEN - 70767

(225)389-1311

1038814-001

JOHNSON, MEREDITH, NP - 1183075

WEST FELICIANA

ST. FRANCISVILLE DANIEL SERVICES, LLC PHY FAMILY PRACTICE /

PEDIATRICS

K 3 2 1614 8500 AGES 0 - 64; ONLY PTS IN

EAST & WEST FELICIANA

PAR

5326 OAK STREET, ST.

FRANCISVILLE - 70775

(225)635-5848

1447951-001

BOBO, DEWANA, NP - 1333620

DANIEL, CHAILLIE, MD - 1483788

HAYDEN, PATTY, NP - 1113387

LINDSEY, TIMOTHY, MD - 1626830

SCHNEIDER, PATRICIA, MD - 1168572

ST. FRANCISVILLE SCHNEIDER LAWRENCE PHY FAMILY PRACTICE S 1 0 370 2500 AGES 0 - 6410289 GOULD DRIVE, SUITE C,

ST. FRANCISVILLE - 70775

(225)635-3269

1168521-001

Page 62 of 233



2REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ASCENSION

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

3

4

3

0

0

0

1

3

10

8

12

2

0

0

0

1

TOTAL 14 33 9 23,197 13,188 13,481

EAST BATON ROUGE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

24

17

18

5

0

3

0

0

50

41

41

7

0

0

0

9

TOTAL 67 148 34 161,706 70,694 71,989

Page 63 of 233



2REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

EAST FELICIANA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

3

0

2

0

6

0

0

0

3

2

2

0

0

0

0

TOTAL 11 7 24 19,047 3,231 3,294

IBERVILLE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

2

2

1

0

1

4

0

5

6

5

2

0

0

0

1

TOTAL 12 19 11 24,990 6,627 6,704

Page 64 of 233



2REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

POINTE COUPEE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

1

2

0

0

2

4

0

0

3

6

2

0

0

0

0

TOTAL 9 11 2 15,446 3,860 3,938

WEST BATON ROUGE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

1

1

0

0

1

0

0

0

1

1

0

0

0

0

0

TOTAL 3 2 1 6,000 3,718 3,796

Page 65 of 233



2REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

WEST FELICIANA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

2

0

0

0

0

0

1

0

3

0

0

0

0

0

TOTAL 2 4 2 11,000 1,266 1,288

Page 66 of 233



REGION 2

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 29

28

3

9

13

0

8

28

11

0

0

0

15

62

66

70

TOTAL 118 224 83 261,386 102,584 104,490

Page 67 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ASSUMPTION

NAPOLEONVILLE ASSUMPTION COMMUNITY HOSPITAL

RURAL HEALTH

RHC RURAL HEALTH

CLINIC

K 0 1 894 1000 AGES 0 - 64143 HIGHWAY 402, SUITE 4,

NAPOLEONVILLE - 70390

(985)369-1083

1948322-001

ORTIS, HOLLIE, NP - 1362824

NAPOLEONVILLE REDDY FAMILY MEDICAL CLINIC OF

NAPOLEONVILLE

RHC RURAL HEALTH

CLINIC

K 2 1 663 1000 AGES 0 - 64154 HIGHWAY 1008,

NAPOLEONVILLE - 70390

(985)369-1880

1445118-001




PIERRE PART FAMILY MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 1 1 261 1000 AGES 0 - 643407 HIGHWAY 70, PIERRE PART

- 70339

(985)252-1000

1948292-001



PIERRE PART LARRISON FAMILY HEALTH CENTER PHY FAMILY PRACTICE K 2 0 263 5000 ASSUMPTION & ST. MARY

PARISH ONLY AGES 0 -

64

3617 HIGHWAY 70, PIERRE PART

- 70339

(985)252-6211

1441015-001

LARRISON, SHERLYN, MD - 1695131

LARRISON, JR., JAMES, MD - 1695122

LAFOURCHE

CUT OFF LADY OF THE SEA MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 1 3 1916 4000 AGES 0 - 64102 WEST 112TH STREET, CUT

OFF - 70345

(985)632-6233

1442861-001

ANGELETTE, ELIZABETH, NP - 1621889

BIRDSALL, GARY, MD - 1366145

BOSSIER, CLAYTON, NP - 1133558

DUPLANTIS, BRETT, PA - 1625990

Page 68 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



CUT OFF SMITH EDDIE PHY FAMILY PRACTICE S 1 0 136 136 CLOSED PANEL103 PICCOLA PARKWAY, CUT

OFF - 70345

(985)325-6226

1357464-001

GOLDEN MEADOW LADY OF THE SEA GOLDEN MEADOW RHC RURAL HEALTH

CLINIC

K 1 3 937 4000 AGES 0 - 64176 WASHINGTON STREET,

GOLDEN MEADOW - 70357

(985)475-5200

1459259-001

FOLSE, LENNY, NP - 1152081

HODSON, DEANNA, NP - 1532312

JACKSON, JOHN, MD - 1030589

MATHERNE, DWIGHT, PA - 1625957

LAROSE LADY OF THE SEA MEDICAL CLINIC -

LAROSE

RHC RURAL HEALTH

CLINIC

K 2 3 1091 3500 AGES 0 - 6413030 HIGHWAY 308, LAROSE -

70373

(985)798-7000

1457671-001

DESSAUER, CHRISTINE, PA - 1625132

FOLSE, LENNY, NP - 1152081

HODSON, DEANNA, NP - 1532312

LUKE, DUANE, MD - 1571652

PITRE, CAMILLE, MD - 1969940

RACELAND BACUTA - TAGORDA LUISA PHY PEDIATRICS K 1 0 390 390 CURRENT PTS AND

SIBLINGS AGES 0 - 17110 ACADIA DRIVE, RACELAND -

70394

(985)537-8687

1394599-001

RACELAND FAMILY DOCTOR CLINIC OF MATHEWS,

THE

PHY FAMILY PRACTICE K 3 1 659 659 CURRENT PATIENTS

AGES 0 - 64111 ACADIA DRIVE, RACELAND -

70394

(985)537-7575

1447943-001

DUPLANTIS, ANDRE, MD - 1238368

HEIDENREICH, JACK, MD - 1901407

MARCELLO, MICHAEL, MD - 1164305

TRANT, ELIZABETH, NP - 1559172

Page 69 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



RACELAND OCHSNER / ST. ANNE INTERNAL

MEDICINE

PHY INTERNAL MEDICINE 2 0 9 9 CLOSED PANEL4608 HIGHWAY 1, RACELAND -

70394

(985)537-2273

1445223-003

NAWAZ, MOHAMMAD, MD - 1688631

SULTAN, AQIB, MD - 1628573

THIBODAUX CENTER FOR PEDIATRIC AND

ADOLESCENT MEDICINE, THE

PHY PEDIATRICS K 2 1 2342 2342 OPEN AGES 0 - 6M; 7M -

14Y CURR PTS; BLOCKED

15-17

604 NORTH ACADIA ROAD, SUITE

200, THIBODAUX - 70301

(985)448-3700

1948446-001

CRUSE, KENNETH, MD - 1986011

GAUDIN, BERNARD, NP - 1993735

PELTIER, HENRY, MD - 1971065

THIBODAUX CHILDREN'S CLINIC OF THIBODAUX,

LLC

PHY PEDIATRICS K 1 0 204 204 CLOSED PANEL807 RIDGEFIELD ROAD,

THIBODAUX - 70301

(985)447-9045

1940739-001

PITRE, SHELIA, MD - 1651435

THIBODAUX KIKRPATRICK DAHLIA PHY PEDIATRIC

HEMATOLOGY -

ONCOLOGY

1 0 281 2500 AGES 21 - 641208 CANAL BOULEVARD,

THIBODAUX - 70301

(985)448-0827

1342246-001

THIBODAUX SAYES R. MARK PHY GENERAL PRACTICE K 1 0 1007 2500 AGES 10 - 20206 EAST 2ND STREET,

THIBODAUX - 70301

(985)447-2629

1953181-001

THIBODAUX THIBODAUX MEDICAL CLINIC PHY INTERNAL MEDICINE K 1 1 1814 3000 AGES 6 - 641214 CARDINAL DRIVE,

THIBODAUX - 70301

(985)446-6381

1448273-001

BABIN, REGENNA, NP - 1333832

TALLURI, GAYATHRI, MD - 1557412

ST. CHARLES

Page 70 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



DESTREHAN CHILDREN'S CLINIC, LLC (site 002) PHY PEDIATRICS K 2 0 1938 5000 AGES 0 - 183 STOREHOUSE LANE, SUITE B,

DESTREHAN - 70047

(985)764-6556

1445924-002

SHUJA, MUHAMMAD, MD - 1314366

STANLEY, EDATTUKARAN, MD - 1312371

DESTREHAN DESTREHAN MEDICAL CLINIC PHY INTERNAL MEDICINE K 2 0 142 142 AGES 18 - 20 CURRENT

PATIENTS, OPEN AGES

21 - 64

12604 RIVER ROAD, DESTREHAN

- 70047

(985)764-0439

1798703-001

DEVARAJAN, V. N., MD - 1182273

JAYAKRISHNAN, C., MD - 1182290

LULING OCHSNER HEALTH CENTER - LULING PHY FAMILY PRACTICE K 1 1 25 3000 AGES 0 - 201057 PAUL MAILLARD ROAD,

LULING - 70070

(985)785-3740

1445223-004

BIRDSALL, WALTER, MD - 1338711

LEDET, ANN, NP - 1493384

LULING SHUKLA NEELA PHY PEDIATRICS K 1 0 1300 2500 AGES 0 - 161207 PAUL MALLARD ROAD,

LULING - 70070

(985)785-9881

1328511-001

LULING ST. CHARLES COMMUNITY HEALTH

CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 7 4 2227 8500 AGES 0 - 64843 MILLING AVENUE, LULING -

70070

(985)785-5800

1444642-001

COMBOY, MICHELLE, NP - 1000361

DAVILLIER, KELLY, MD - 1420565

DAWSON, ROBERT, MD - 1955191


HADI, MOHAMMED, MD - 1106267

HARTMAN, MARY, NP - 1551261

JOSEPH, KEVIN, MD - 1486965


MARDIA, SUDHA, MD - 1576018

SAGDEPHOUR, BAHRAM, MD - 1385671


Page 71 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LULING ST. CHARLES MEDICAL CLINIC PHY INTERNAL MEDICINE 2 0 28 28 CLOSED PANEL1057 PAUL MAILLARD, SUITE 240,

LULING - 70070

(985)785-2045

1792292-001

DEVARAJAN, V. N., MD - 1182273

JAYAKRISHNAN, C., MD - 1182296

LULING VIAL - BENSON MONICA PHY INTERNAL MEDICINE K 1 0 370 2500 AGES 13 - 64126 POST DRIVE, LULING - 70070

(985)785-6204

1174726-001

ST. JAMES

GRAMERCY ST. JAMES PRIMARY CARE RHC RURAL HEALTH

CLINIC

K 3 1 1685 2500 AGES 0 - 64827 NORTH PINE STREET,

GRAMERCY - 70052

(225)869-9200

1448800-001

ROUSSEL, TONI, NP - 1725251

THATIKONDA, NARENDER, MD - 1020834

VELLANKI, ANU, MD - 1559571

VELLANKI, APARNA, MD - 1131385

VACHERIE S K DONEPUDI MD APMC PHY FAMILY PRACTICE /

GENERAL SURGERY

K 1 1 247 3000 AGES 6 - 6421420 HIGHWAY 20 WEST,

VACHERIE - 70090

(225)265-3013

1036692-001

DONEPUDI, SARAT, MD - 1197530

WAGUESPACK, FRANCINE, NP - 1113379

VACHERIE ST. JOSEPH MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 3 0 737 7500 AGES 0 - 6422080 LA HIGHWAY 20 WEST,

VACHERIE - 70090

(225)265-3061

1449792-001

ORY, MICHAEL, MD - 1105155

RANDOLPH, ROZALYNDE, MD - 1681601

TALLURI, RAJA, MD - 1549029

Page 72 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



VACHERIE ST. PHILIP CLINIC PHY GENERAL PRACTICE K 2 0 707 707 CURRENT PATIENTS

AGES 0 - 641108 ST. JAMES STREET,

VACHERIE - 70090

(225)265-4087

1442224-001

NORTON, LYDIA, MD - 1486281

WAGUESPACK, ROLAND, MD - 1090123

ST. JOHN

EDGARD TECHE ACTION CLINIC - EDGARD

PRIMARY CARE CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 1 76 1000 AGES 0 - 64159 EAST THIRD STREET,

EDGARD - 70049

(985)497-8726

1940925-002

WHIPPLE, HANNAH, NP - 1109193

LAPLACE AVOTRI KOSI PHY PEDIATRICS S 1 0 202 2500 AGES 0 - 201819 WEST AIRLINE HIGHWAY,

SUITE 10, LAPLACE - 70068

(985)651-5751

1794414-001

LAPLACE CHILDREN'S HOSPITAL MEDICAL


PHY PEDIATRICS K 2 0 707 707 NEW PTS AGES BIRTH - 1

YR; CURRENT PTS AGES

2 - 20

501 RUE DE SANTE, SUITE 13,

LAPLACE - 70068

(985)652-6359

1946711-010

LAWRENCE, REITA, MD - 1696463

MICHEL, JAIME, MD - 1055859

LAPLACE PEDIATRIC MEDICAL CLINIC (site 001) PHY PEDIATRICS K 1 0 1307 2500 AGES 0 - 20501 RUE DE SANTE, SUITE 9,

LAPLACE - 70068

(985)651-7444

1449369-001

LAMBERT, OLIVER, MD - 1324906

LAPLACE RAINBOW PEDIATRICS PHY PEDIATRICS K 3 0 1135 1135 CURRENT PATIENTS AND

SIBLINGS AGES 0 - 18451 RUE DE SANTE, LAPLACE -

70068

(985)652-4400

1441490-001

DEFRANK, WENDI, MD - 1967599

FOTI, KAREN, MD - 1579459

JONES, NICOLE, MD - 1153567

Page 73 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LAPLACE ST. JAMES PRIMARY CARE RHC RURAL HEALTH

CLINIC

K 3 1 1593 3000 AGES 0 - 64502 RUE DE SANTE, SUITE 301,

LAPLACE - 70068

(985)652-5475

1457621-001

ROUSSEL, TONI, NP - 1725251

THATIKONDA, NARENDER, MD - 1020834

VELLANKI, ANU, MD - 1559571

VELLANKI, APARNA, MD - 1131385

LAPLACE SUNRISE PEDIATRICS PHY PEDIATRICS K 4 0 295 295 CURRENT PATIENTS

AGES 0 - 20501 RUE DE SANTE, SUITE 1,

LAPLACE - 70068

(985)652-9494

1940534-002

BUSENLENA, TANYA, MD - 1699705

DANNA, III, NICHOLAS, MD - 1187763

DEFRANCE, DIANNE, MD - 1917150

MASACARENHAS, VIMALA, MD - 1906760

RESERVE FAMILY MEDICINE CENTER OF

RESERVE

RHC RURAL HEALTH

CLINIC

K 1 2 1407 3500 AGES 0 - 64147 CENTRAL AVENUE, RESERVE

- 70084

(985)536-2605

1527301-001

ALBRECHT, ROBERT, MD - 1051012

DAIGLE, SHELLY, PA - 1375641

MARCELLE, VINNIE, NP - 1314455

ST. MARY

BALDWIN FRANKLIN FOUNDATION HOSPITAL PHY INTERNAL MEDICINE 1 0 14 2500 AGES 21 - 64100 LIVE OAK STREET, BALDWIN

- 70514

(337)923-7040

1795992-002

MCPHERSON, STEVEN, MD - 1061646

FRANKLIN ACADIANA FAMILY PRACTICE (PPM) RHC RURAL HEALTH

CLINIC

K 2 0 748 5000 AGES 0 - 641501 BETHIA, FRANKLIN - 70538

(337)828-3507

1948900-001

ALLAIN, BRENT, MD - 1197041

HORTON, RANDALL, MD - 1197050

Page 74 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



FRANKLIN CHUA JESUS PHY FAMILY PRACTICE K 1 0 268 2500 AGES 0 - 64602 HAIFLEIGH STREET,

FRANKLIN - 70538

(337)828-4037

1969036-001

FRANKLIN GUNDA SHARAD PHY PEDIATRICS K 1 0 1776 2500 AGES 0 - 15606 HAIFLEIGH, FRANKLIN - 70538

(337)828-4440

1541192-001

FRANKLIN MCCORMICK LOUIS PHY FAMILY PRACTICE K 1 0 671 2500 AGES 0 - 64606 HAIFLEIGH, FRANKLIN - 70538

(337)828-4440

1197068-001

FRANKLIN TECHE ACTION CLINIC FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 4 2 820 11000 AGES 0 - 641115 WEBER STREET, FRANKLIN

- 70538

(337)828-2550

1940925-001

BROUSSARD, WILFRED, PA - 1624888

CURZON, JR., EUGENE, MD - 1657751

EL - KHAWAND, DOMINIQUE, MD - 1065790

GAUTAM, CHAKSHU, MD - 1160164

MILLER, CANDICE, NP - 1015857

WILTZ, GARY, MD - 1321532

FRANKLIN WELCH - SPENCER KEIDRA PHY FAMILY PRACTICE K 1 0 136 136 CURRENT PTS,

DEPENDANTS &

SIBLINGS AGES 6 - 64

1420 NORTHWEST BOULEVARD,

SUITE 4, FRANKLIN - 70538

(337)828-3090

1012246-001

MORGAN CITY ALBERT LIANTER PHY INTERNAL MEDICINE 1 0 268 268 CURRENT PATIENTS

AGES 21 - 641151 MARGUERITE STREET,

SUITE 600, MORGAN CITY - 70380

(985)384-3160

1345172-001

Page 75 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MORGAN CITY BASS SHARON PHY FAMILY PRACTICE S 1 0 385 2500 AGES 0 - 181300 LAKEWOOD DRIVE, SUITE

G, MORGAN CITY - 70380

(985)385-2710

1676934-001

MORGAN CITY BLEREAU ROBERT PHY FAMILY PRACTICE K 1 0 517 517 CURRENT PTS AGES 2 -

64; ACCEPTS PTS BIRTH -

1

1122 EIGHTH STREET, MORGAN

CITY - 70380

(985)385-3000

1083828-001

MORGAN CITY PEDIATRIC CLINIC OF ST. MARY

PARISH, THE

PHY PEDIATRICS K 5 0 4490 12500 AGES 0 - 201234 DAVID DRIVE, SUITE A,

MORGAN CITY - 70380

(985)384-2430

1441341-001

MENINA, ERICA, MD - 1054887

NEWELL, JR., JOHN, MD - 1350567

SALEME, ANTHONY, MD - 1102601

THORGUSON, KIMBERLY, MD - 1576778

WILSON, OLEITHA, MD - 1422371

TERREBONNE

HOUMA ARUNAVATHI SANGISETTY MD APMC PHY PEDIATRICS K 4 1 6029 10500 AGES 0 - 201281 WEST TUNNEL

BOULEVARD, HOUMA - 70360

(985)876-2321

1446106-001

NAPOLOVA, OLGA, MD - 1454028

RAMADOSS, EASWAR, MD - 1468240

RISENER, FREDERICK, MD - 1979619

SANGISETTY, ARUNAVATHI, MD - 1335771

WISE, ANNIE, NP - 1154636

HOUMA AUDUBON PEDIATRICS, LLC PHY PEDIATRICS K 2 0 930 5000 OPEN AGES 0 -

3MONTHS; BLOCKED

AGES 4MNTHS - 18 YR

216 MYSTIC BOULEVARD, SUITE

B, HOUMA - 70360

(985)868-9339

1459313-001

HARRIS, KIMIYO, MD - 1489719

KERLEY, NICOLE, MD - 1575917

Page 76 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



HOUMA BAYOU PEDIATRIC ASSOCIATES, APMC PHY PEDIATRICS K 5 1 4749 18000 AGES 0 - 20; ACCEPTS

AGES 0 - 15 ONLY8120 MAIN STREET, SUITE 300,

HOUMA - 70360

(985)872-6405

1945587-001

BARNER, KIMBERLY, MD - 1482978

CLARKE, JR., ROBERT, MD - 1347981

FERRER, BERNARD, MD - 1558362

GALLAGHER, RUTHANNE, MD - 1316539

HERBERT, MATTHEW, NP - 1552984

TOTINA, ALBERT, MD - 1300322

HOUMA DAVULURI CHILDRENS CLINIC PHY PEDIATRICS K 1 1 1953 3000 AGES 0 - 211020 LEE AVENUE, HOUMA -

70360

(985)868-7500

1884553-001

DAVULURI, MURALI, MD - 1368750

QUATMAN, CATHERINE, NP - 1506800

HOUMA FADI ABOU - ISSA, MD A MEDICAL LLC PHY INTERNAL MEDICINE 1 0 59 59 CLOSED PANEL8120 MAIN STREET, SUITE 301,

HOUMA - 70360

(985)851-6653

1446165-001

ABOU - ISSA, FADI, MD - 1688525

HOUMA HOUMA HEALTH CLINIC LLC PHY INTERNAL MEDICINE 1 1 482 3000 AGES 21 - 64827 BAYOU GARDEN

BOULEVARD, HOUMA - 70364

(985)853-2343

1448842-001

QUATMAN, CATHERINE, NP - 1506800

WALKER, PATRICK, MD - 1101630

HOUMA INTERNAL MEDICINE ASSOCIATES OF

HOUMA

PHY INTERNAL MEDICINE 2 2 26 6000 AGES 21 - 64 ONLY

RESIDENTS OF TARC855 BELANGER STREET, SUITES

102, HOUMA - 70360

(985)873-2961

1442704-001

CINNATER, RAY, MD - 1090891

DUPONT, JR, JULESS, MD - 1005738

RHODES, JULIE, NP - 1432423

WARREN, NANCY, NP - 1569534

Page 77 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



HOUMA INTERNAL MEDICINE CLINIC OF HOUMA PHY INTERNAL MEDICINE S 1 2 43 43 CLOSED PANEL911 VERRET STREET, HOUMA -

70360

(985)876-7388

1796395-001

AUTHEMENT, LISA, NP - 1030431

HENRY, RUSSELL, MD - 1176885

WINDHAM, ANNETTE, NP - 1434388

HOUMA OGDEN MOIRA PHY GENERAL PRACTICE S 1 0 63 63 CURRENT PATIENTS

AGES 16 - 648120 MAIN STREET, SUITE 403,

HOUMA - 70360

(985)868-3737

1485284-001

HOUMA SANUSI ABAYOMI PHY INTERNAL MEDICINE 1 0 43 2500 AGES 21 - 64325 LIBERTY STREET, HOUMA -

70360

(985)879-3600

1882780-001

Page 78 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



HOUMA SOUTH LOUISIANA MEDICAL

ASSOCIATION (site 001)

PHY FAMILY PRACTICE K 24 9 5982 70000 AGES 0 - 641990 INDUSTRIAL BOULEVARD,

HOUMA - 70360

(985)873-1730

1441830-001

ARCEMENT, LEE, MD - 1482871

AUTRY, ERNEST, MD - 1622664

BEGNEAUD, WALLACE, MD - 1099392

BOFFY, NATHALIE, PA - 1347019

BONIN, SHEILA, NP - 1180092

BROOKE, RICHARD, MD - 1351466

CHARPENTIER, JENNIFER, NP - 1993743

CINTRON, DEBORAH, MD - 1399507

CROWE, JR., JAMES, MD - 1073938

DAQUANA, HOLLY, NP - 1169897

DELORD, TERRY, MD - 1965553

DUPONT, ADELA, MD - 1316547

ESCHETE, MARY, MD - 1193631

FALGOUT, JOHN, NP - 1682004

FRANKLIN, COLERIDGE, MD - 1198137

GRAFTON, CAROLINE, NP - 1621757

GUPTA, SHAMINDA, MD - 1489697

HEMELT, BRENT, MD - 1539295

HEMELT, CHERI, MD - 1577243

JOHNSON, THERRYLL, MD - 1328863

LAO, JIMMY, MD - 1998222

LUNYONG, VICTOR, MD - 1359131

MANN, ELENA, MD - 1067547

MARMANDE, WILLIAM, MD - 1065358

MARTINEZ, JORGE, MD - 1321371

MARTS, RONALD, MD - 1933741

MEGISON, JOHN, MD - 1138746

MORGAN, CARA, MD - 1696447

PEREZ, CARLOS, MD - 1379816

RAMIREZ, LAURA, PA - 1351636

REAVES, RACHEL, NP - 1530646

RICKS, KEVIN, PA - 1626759

SIMMONS, RHONESIA, MD - 1056235

Page 79 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



HOUMA SUGARLAND PEDIATRICS LLC PHY PEDIATRICS K 1 0 764 764 CLOSED PANEL5642 WEST MAIN STREET,

HOUMA - 70360

(985)853-2273

1011649-001

BER, LESLIE, MD - 1490318

HOUMA TECHE ACTION CLINIC - DULAC FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 1 909 1000 AGES 0 - 64189 MOZART DRIVE, HOUMA -

70360

(985)868-3700

1940925-003

MOLINERE, STACEY, NP - 1149284

HOUMA TECHE ACTION CLINIC @ HOUMA FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 1 221 3000 AGES 0 - 64809 WEST TUNNEL BOULEVARD,

HOUMA - 70360

(985)851-1717

1452823-001

CLAY, LORI, NP - 1422541

MORGAN, CARA, MD - 1696447

WALKER, PATRICK, MD - 1101630

Page 80 of 233



3REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ASSUMPTION

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

1

0

0

0

3

0

0

2

3

0

0

0

0

0

TOTAL 4 5 3 8,000 3,567 3,657

LAFOURCHE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

3

2

2

1

0

0

3

1

4

4

6

2

0

0

0

1

TOTAL 12 17 12 23,240 12,741 13,277

Page 81 of 233



3REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ST. CHARLES

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

3

1

0

0

1

0

0

5

6

2

1

0

0

0

2

TOTAL 7 16 5 21,670 6,889 7,056

ST. JAMES

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

1

1

0

0

2

0

2

4

1

1

0

0

0

1

TOTAL 4 9 2 13,707 3,922 3,978

Page 82 of 233



3REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ST. JOHN

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

5

0

0

0

0

1

2

0

11

3

0

1

0

0

0

0

TOTAL 8 15 4 14,637 9,270 9,457

ST. MARY

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

2

5

0

0

1

1

0

6

3

8

0

2

0

0

0

TOTAL 11 19 2 41,921 10,547 10,789

Page 83 of 233



3REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

TERREBONNE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

5

5

1

1

0

2

0

0

15

13

6

3

6

0

0

3

TOTAL 14 46 19 122,929 18,556 19,434

Page 84 of 233



REGION 3

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 17

12

1

11

5

0

3

11

7

0

0

8

8

35

43

26

TOTAL 60 127 47 246,104 65,492 67,648

Page 85 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ACADIA

CHURCHPOINT FELTON MICHAEL PHY FAMILY PRACTICE S 1 0 325 650 LIMITED PANEL; AGES 0 -

64814 SOUTH BROADWAY,

CHURCHPOINT - 70525

(337)684-3178

1920967-001

CHURCHPOINT HARGRODER MEDICAL INC PHY FAMILY PRACTICE S 1 1 92 92 CLOSED PANEL820 SOUTH BROADWAY STREET,

CHURCHPOINT - 70525

(337)684-5232

1038458-001

HARGRODER, TY, MD - 1398501

STELLY, CINDY, NP - 1038431

CHURCHPOINT POLANCO MARCELO PHY GENERAL PRACTICE S 1 0 777 2500 AGES 0 - 64731 SOUTH MAIN STREET, SUITE

A, CHURCHPOINT - 70525

(337)684-0911

1485438-001

CROWLEY ACADIA FAMILY CLINIC LLC RHC RURAL HEALTH

CLINIC

K 0 1 233 1000 AGES 0 - 64703 EAST 8TH STREET,

CROWLEY - 70526

(337)788-1081

1037745-001

MILLER, GINA, NP - 1780944

CROWLEY BRILEY - WALKER NANCY PHY FAMILY PRACTICE 1 0 137 130 LIMITED PANEL; AGES 21

- 641307 CROWLEY RAYNE

HIGHWAY, SUITE C, CROWLEY -

70526(337)788-3032

1075728-001

CROWLEY CANNON STEPHEN PHY FAMILY PRACTICE S 1 0 258 258 CURRENT PATIENTS

AGES 0 - 64719 NORTH EASTERN AVENUE,

CROWLEY - 70526

(337)783-5900

1048577-001

Page 86 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



CROWLEY CROWLEY WALK-IN CLINIC PHY PEDIATRICS / FAMILY

PRACTICE

K 2 1 2643 5500 AGES 0 - 64621 NORTH AVE K, CROWLEY -

70526

(337)783-8215

1451614-001

KORAB, MAZEN, MD - 1161322

KORAB, YAMEN, MD - 1014168

MORON, MARY, NP - 1140082

CROWLEY DELAHOUSSAYE BENTON PHY OBGYN 1 0 23 500 LIMITED

PANEL;CURRENT PTS

FEMALE ONLY AGES 21 -

64

1307 CROWLEY - RAYNE

HIGHWAY, SUITE A, CROWLEY -

70526(337)783-3861

1097110-001

CROWLEY ELFERT JOSEPH PHY PEDIATRICS K 1 0 1984 2500 AGES 0 - 181325 WRIGHT AVENUE, TOWER

1, SUITE F, CROWLEY - 70526

(337)783-2915

1328502-001

CROWLEY FAMILY CLINIC OF CROWLEY, THE PHY FAMILY PRACTICE S 2 1 241 241 CURRENT PATIENTS

AGES 0 - 64345 ODDFELLOWS ROAD,

CROWLEY - 70526

(337)783-7004

1949833-001

KILGORE, KARRIE, MD - 1679411

MURRAY, KELLY, NP - 1149837

STRINGFELLOW, PAUL, MD - 1679267

CROWLEY HOLDEN JOE PHY GENERAL PRACTICE K 1 0 493 2500 AGES 12 - 64421 NORTH AVENUE F,

CROWLEY - 70526

(337)788-0832

1027359-001

CROWLEY KATIRA MULRAJ PHY INTERNAL MEDICINE 1 0 6 6 CLOSED PANEL1455 WRIGHT AVENUE, SUITE B,

CROWLEY - 70526

(337)788-1733

1306576-001

Page 87 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



CROWLEY KRISHEN SWEETIE PHY PEDIATRICS K 1 0 1442 2500 AGES 0 - 18; ACCEPTING

NEW PTS AGES 0 - 14

ONLY


HIGHWAY, SUITE B, CROWLEY -

70526(337)783-6857

1693197-001

CROWLEY MELANSON MICHAEL PHY OBGYN 1 0 48 500 LIMITED

PANEL;CURRENT PTS

FEMALE ONLY AGES 21 -

64


HIGHWAY, SUITE B, CROWLEY -

70526(337)783-3861

1312487-001

CROWLEY MENARD RONALD PHY FAMILY PRACTICE 1 0 44 350 LIMITED PANEL; AGES 21

- 641307 CROWLEY - RAYNE

HIGHWAY, SUITE C, CROWLEY -

70526(337)788-3032

1319384-001

CROWLEY SAINI SATINDER PHY INTERNAL MEDICINE 1 0 259 2500 AGES 21 - 641455 WRIGHT AVENUE,

CROWLEY - 70526

(337)788-1733

1154962-001

RAYNE ACADIANA FAMILY MEDICAL

ASSOCIATES

PHY PEDIATRICS / FAMILY

PRACTICE


AGES 0 - 64717 CURTIS DRIVE, RAYNE -

70578

(337)334-7551

1440078-001

CURTIS, D. THOMAS, MD - 1352365

DAWSON, MARK, MD - 1197823

DUHON, NEAL, MD - 1357863

HUMBLE, KENT, MD - 1991571

EVANGELINE

BASILE DESHOTEL BOBBY PHY GENERAL PRACTICE K 1 0 247 2500 AGES 0 - 641431 FUSILIER, BASILE - 70515

(337)432-6637

1054194-001

Page 88 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MAMOU ARDOIN BRENT PHY INTERNAL MEDICINE S 1 0 92 92 CURRENT PATIENTS

AGES 6 - 64728 POINCIANA AVENUE, MAMOU

- 70554

(337)468-0267

1347698-001

MAMOU BAKARE MEENA PHY PEDIATRICS K 1 0 767 2500 AGES 0 - 201008 SIXTH STREET, MAMOU -

70554

(337)468-2515

1331384-001

MAMOU CUTTER CHRISTOPHER PHY FAMILY PRACTICE K 1 0 158 158 NEW PTS AGES 0 - 20;


64

704 PONICIANA AVENUE, SUITE

C, MAMOU - 70554

(337)468-4038

1468509-001

MAMOU FONTENOT JOHN PHY INTERNAL MEDICINE 1 0 105 105 CURRENT PATIENTS

ONLY AGES 21 - 641415 7TH STREET, SUITE J,

MAMOU - 70554

(337)468-5150

1066125-001

MAMOU KULKARNI UPENDRA PHY OBGYN S 1 0 139 2500 FEMALES ONLY, AGES 10

- 64805 CHERRY STREET, MAMOU -

70554

(337)468-2250

1303020-001

MAMOU RODRIGUEZ OSCAR PHY INTERNAL MEDICINE 1 0 154 2500 AGES 21 - 641413 SEVENTH STREET, SUITE B,

MAMOU - 70554

(337)468-3310

1314544-001

MAMOU SAVOY GREGORY PHY GENERAL SURGERY S 1 0 45 45 CURRENT PATIENTS

AGES 0 - 641508 CAJUN DRIVE, SUITE B,

MAMOU - 70554

(337)468-5309

1099805-001

Page 89 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



VILLE PLATTE ALTAMIRANO DODANIM PHY PEDIATRICS K 1 0 1733 2500 AGES 0 - 20504 JACK MILLER ROAD, SUITE 3,

VILLE PLATTE - 70586

(337)363-3560

1671177-001

VILLE PLATTE ARDOIN GREGORY PHY INTERNAL MEDICINE /

PULMONARY

DISEASES

1 0 52 52 CLOSED PANEL503 JACK MILLER ROAD, SUITE B,


(337)363-7036

1385425-001

VILLE PLATTE ASWELL - III CHARLES PHY INTERNAL MEDICINE 1 0 84 84 CURRENT PATIENTS

AGES 21 - 64503 JACK MILLER ROAD, SUITE A,


(337)363-7474

1188531-001

VILLE PLATTE DUPRE HENRY PHY GENERAL PRACTICE K 1 0 329 329 AGES 18 MTHS-18 YRS;

CURRENT PATIENTS AGE

19 - 64

1008 WEST MAIN STREET, VILLE

PLATTE - 70586

(337)363-5531

1157945-001

VILLE PLATTE FONTENOT CHARLES PHY FAMILY PRACTICE S 1 0 481 2500 AGES 1 - 641535 WEST MAIN STREET, SUITE

6, VILLE PLATTE - 70586

(337)363-5521

1101923-001

VILLE PLATTE FONTENOT THOMAS PHY GENERAL PRACTICE S 1 0 251 251 CURRENT PATIENTS

AGES 0 - 64417 EAST LINCOLN ROAD, VILLE

PLATTE - 70586

(337)363-7744

1368296-001

VILLE PLATTE SOILEAU THOMAS PHY GENERAL PRACTICE S 1 0 99 99 CURRENT PATIENTS

AGES 0 - 64504 JACK MILLER ROAD, SUITE 4,


(337)363-6480

1135054-001

Page 90 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



VILLE PLATTE TASSIN A. JOHN PHY GENERAL PRACTICE S 1 0 872 2500 AGES 0 - 641535 WEST MAIN STREET, SUITE

1, VILLE PLATTE - 70586

(337)363-5591

1105341-001

VILLE PLATTE VIDRINE STEVEN PHY GENERAL PRACTICE S 1 0 134 134 CURRENT PATIENTS

AGES 0 - 64417 EAST LINCOLN ROAD, VILLE

PLATTE - 70586

(337)363-8033

1378046-001

VILLE PLATTE VIDRINE COMMUNITY CLINIC, LLC PHY FAMILY PRACTICE K 2 1 1328 5500 AGES 0 - 64; ACCEPTING

PATIENTS AGES 0 - 20

ONLY

4940 VIDRINE ROAD, VILLE

PLATTE - 70586

(337)506-3500

1440167-001

LAHAYE, NICHOLAS, MD - 1491675

LAHAYE, WAYNE, MD - 1068501

LAUNEY, BRITNEY, PA - 1026671

IBERIA

JEANERETTE BOURGEOIS LEONARD PHY FAMILY PRACTICE K 1 0 61 61 CURRENT PATIENTS

AGES 6 - 641409 CHURCH STREET,

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(337)942-5899

1084310-001

OPELOUSAS BOULET, JR. L. H. PHY FAMILY PRACTICE S 1 0 63 63 CLOSED PANEL8676 HIGHWAY 182, OPELOUSAS

- 70570

(337)942-6324

1090085-001

OPELOUSAS BOURGEOIS GEORGE PHY INTERNAL MEDICINE 1 0 49 50 LIMITED PANEL; AGES 21

- 64519 EAST PRUDHOMME STREET,

OPELOUSAS - 70570

(337)942-5384

1014834-001

Page 104 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



OPELOUSAS CHATMAN ERIC PHY INTERNAL MEDICINE S 1 0 31 31 CURRENT PATIENTS

AGES 14 - 641200 HOSPITAL DRIVE, SUITE 5,

OPELOUSAS - 70570

(337)948-8269

1574368-001

OPELOUSAS FAMILY CLINIC, INC. PHY FAMILY PRACTICE K 5 0 580 580 AGES 0 - 18; CURRENT

PATIENTS AGES 19 - 643921 I - 49 SOUTH SERVICE

ROAD, OPELOUSAS - 70570

(337)942-5706

1941492-001

BASILE, MICHAEL, MD - 1313874

BRAHAM, LAURA, MD - 1577952

GUILLORY, KEVIN, MD - 1036617

KELLY, LATONYA, MD - 1066443

MONTGOMERY, MICHAEL, MD - 1152285

OPELOUSAS GLOWACKI GREGORY PHY PEDIATRICS S 1 0 1939 2500 AGES 0 - 201200 HOSPITAL DRIVE, SUITE 2,

OPELOUSAS - 70570

(337)942-4453

1321010-001

OPELOUSAS GREAT BEGINNINGS PEDIATRIC AND

ADOLESCENT MEDICINE

PHY PEDIATRICS K 1 1 2548 3000 AGES 0 - 183975 I - 49 SOUTH SERVICE

ROAD, SUITE 201, OPELOUSAS -

70570(337)407-2795

1449687-001

ANDERSON, BALISTINE, PA - 1627372

JOHNSON, CARMEN, MD - 1434108

OPELOUSAS GREENE CRAIG PHY GENERAL PRACTICE S 1 0 162 162 CURRENT PATIENTS

AGES 0 - 642967 SOUTH UNION STREET,

OPELOUSAS - 70570

(337)594-8958

1420921-001

OPELOUSAS GUIDRY JOHN PHY INTERNAL MEDICINE 1 0 10 10 CURRENT PATIENTS

AGES 21 - 643975 I 49 S SERVICE ROAD,

SUITE 230, OPELOUSAS - 70570

(337)948-4019

1331902-001

Page 105 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



OPELOUSAS JONES, III THOMAS PHY PEDIATRICS S 1 0 2009 2500 AGES 0 - 201200 HOSPITAL DRIVE, SUITE 2,

OPELOUSAS - 70570

(337)942-4453

1310824-001

OPELOUSAS KOUBICEK CARMEN PHY PEDIATRICS K 1 0 1256 2500 AGES 0 - 181270 ATTAKAPAS DRIVE, SUITE

401K, OPELOUSAS - 70570

(337)407-0084

1565911-001

OPELOUSAS METOYER MEDICAL CORPORATION PHY FAMILY PRACTICE S 2 1 440 440 CLOSED PANEL204 WEST NORTH STREET,

OPELOUSAS - 70570

(337)948-4445

1023540-001

GALLOW, LEON, NP - 1023558

METOYER, DEREK, MD - 1679682

METOYER, LANA, MD - 1676098

OPELOUSAS RICHARD ARLENE PHY FAMILY PRACTICE 1 0 175 175 CURRENT PATIENTS

AGES 21 - 64507 NORTH MARKET STREET,

OPELOUSAS - 70570

(337)948-1212

1371751-001

OPELOUSAS SANCHEZ LURIS PHY FAMILY PRACTICE K 1 0 290 2500 AGES 0 - 64; ACCEPTING

NEW PTS AGES 0 - 21

ONLY

828 CRESWELL LANE,

OPELOUSAS - 70570

(337)942-8088

1999296-001

OPELOUSAS SOUTHWEST LA PRIMARY HEALTH

CARE

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 1 1137 3000 AGES 0 - 648762 HIGHWAY 182 NORTH,

OPELOUSAS - 70570

(337)942-2005

1941859-001

CHARLES, WRONETTA, NP - 1479438


Page 106 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



OPELOUSAS WHITE CALVIN PHY FAMILY PRACTICE 1 0 111 111 CLOSED PANEL1119 PRUDHOMME CIRCLE,

OPELOUSAS - 70570

(337)942-1320

1322911-001

PORT BARRE FANDAL FREDDIE PHY FAMILY PRACTICE K 1 0 541 2500 OPEN PANEL AGES 0 -

20; BLOCKED PANEL

AGES 21 - 64

17695 U. S. HIGHWAY 190, PORT

BARRE - 70577

(337)585-7898

1430692-001

PORT BARRE MAYEAUX STACEY PHY FAMILY PRACTICE K 1 0 51 2500 AGES 0 - 2017695 HIGHWAY 190, PORT

BARRE - 70577

(318)585-7898

1423271-001

SUNSET SUNSET MEDICAL CLINIC, LLC PHY FAMILY PRACTICE S 4 0 1224 1224 AGES 6M - 18Y; CURRENT

PTS & SIBLINGS AGES 19

- 64

990 NAPOLEON AVENUE,

SUNSET - 70584

(337)662-5248

1943142-001

BURLET, III, ROBERT, MD - 1569011

DAIGLE, RANDY, MD - 1490792

DUGAL, JOHN CHARLES, MD - 1148237

SIBILLE, JOHN SCOTT, MD - 1975206

WASHINGTON GILLESPIE PATRICK PHY FAMILY PRACTICE S 1 0 172 150 MAX CAPACITY

EXCEEDED; LIMITED

PANEL;CURR PTS 0-64


WASHINGTON - 70589

(337)826-8044

1913677-001

ST. MARTIN

BREAUX BRIDGE MED ED OF LOUISIANA INC PHY FAMILY PRACTICE K 1 1 1920 1920 AGES 0 - 20 & AGES

50-64; CURRENT PTS

AGES 21-49

206 CHAMPAGNE BOULEVARD,

SUITE B, BREAUX BRIDGE - 70517

(337)332-0222

1449300-001

KHORSANDI, JAHANYAR, MD - 1484687

MARGAGLIO, TERESA, NP - 1671002

Page 107 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BREAUX BRIDGE PEDIATRIC GROUP OF ACADIANA (site

004)

PHY PEDIATRICS K 4 0 1617 2500 AGES 0 - 191442 EAST BRIDGE STREET,

BUILDING C, BREAUX BRIDGE -

70517(337)332-3971

1440604-004

ABOU - TURK, CHIRINE, MD - 1456578


BROWN, JIL, MD - 1389781

OBENZA, MARITA, MD - 1168203

ST. MARTINVILLE ST MARTINVILLE MATERNAL - CHILD

CLINIC

RHC RURAL HEALTH

CLINIC

K 4 1 2635 3000 OPEN AGES 0 - 18;

FEMALES ONLY AGES 19

- 64

1119 NORTH MAIN STREET, ST.

MARTINVILLE - 70582

(337)394-7774

1027545-001



FILHO, FERMIN, MD - 1373796

FOGLEMAN, TRENT, MD - 1574546

HABETZ, COURTNEY, PA - 1407208

ST. MARTINVILLE ST. MARTIN PARISH COMMUNITY

HEALTH CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 1 212 3000 AGES 0 - 64317 DERINER STREET, ST.

MARTINVILLE - 70582

(337)342-2566

1028088-001

CASTILLE, JR, WARTELLE, MD - 1075850

HATCH, SHERRI, NP - 1458597

ST. MARTINVILLE WILTZ DANIEL PHY FAMILY PRACTICE 1 0 19 19 CLOSED PANEL1117 NORTH MAIN STREET,

SUITE B, ST. MARTINVILLE -

70582(337)394-7111

1493465-001

VERMILION

ABBEVILLE ABBEVILLE COMMUNITY HEALTH

CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 1 471 3000 AGES 0 - 64800 CHARITY STREET,

ABBEVILLE - 70510

(337)893-3443

1440825-001

MARSHALL, MARILYN, MD - 1554715

VERDEFLOR, DIANA, NP - 1136727

Page 108 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ABBEVILLE ABBEVILLE GENERAL HOSPITAL CLINIC RHC RURAL HEALTH

CLINIC

K 5 1 571 1000 AGES 0 - 642419 ALONZO STREET,

ABBEVILLE - 70510

(337)892-0630

1448087-001

AYMOND, CHER, MD - 1420085

BOUDREAUX, MANDY, MD - 1706639

HARRINGTON, MELISA, MD - 1042196

MEEKS, CLAUDE, MD - 1075795

PELLERIN, JR., GILBERT, MD - 1045675

RATLIFF, JULIE, NP - 1127621

ABBEVILLE GUPTA (site 002) PADMINI PHY PEDIATRICS K 1 0 391 2500 AGES 0 - 20323 ODEA, ABBEVILLE - 70510

(337)898-9503

1316989-002

ABBEVILLE MANUEL MEDICAL CLINIC PHY PEDIATRICS K 3 0 2980 7500 AGES 0 - 202405 ALONZO, ABBEVILLE - 70510

(337)893-3722

1940623-001

BISQUERA, JENNIFER, MD - 1163775

MANUAL, POWLIN, MD - 1171689

SUGENG, BUDI, MD - 1330531

ABBEVILLE PEDIATRIC GROUP OF ACADIANA, LLC PHY PEDIATRICS K 3 0 358 2500 AGES 0 - 201049 WEST SUMMERS DRIVE,

ABBEVILLE - 70510

(337)442-6240

1440604-006



SUGENG, BUDI, MD - 1330531

ABBEVILLE SILAR DAVID PHY FAMILY PRACTICE S 1 0 385 1000 LIMITED PANEL; AGES 6

MONTHS - 64 YEARS121 TIVOLI STREET, SUITE A,

ABBEVILLE - 70510

(337)893-9871

1694347-001

Page 109 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



GUEYDAN GARDINER CENTER HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 1 1 274 1000 AGES 0 - 64710 5TH STREET, GUEYDAN -

70542

(337)536-9262

1448028-001

BERGEAUX, SCOTT, MD - 1072419

KLORER, SUSAN, NP - 1105619

KAPLAN BERGEAUX SCOTT PHY FAMILY PRACTICE S 1 0 254 2500 AGES 1 - 641402 WEST 8TH STREET, KAPLAN

- 70548

(337)643-6219

1072419-001

KAPLAN GUPTA (site 001) PADMINI PHY PEDIATRICS K 1 0 663 2500 AGES 0 - 20801 MONTGOMERY, KAPLAN -

70548

(337)643-8400

1316989-001

KAPLAN LELEUX PATRICK PHY EMERGENCY

MEDICINE

1 0 13 2500 AGES 21 - 64202 NORTH JACKSON AVENUE,

KAPLAN - 70548

(337)643-1655

1090476-001

KAPLAN PATEL SURESH PHY INTERNAL MEDICINE 1 0 35 50 LIMITED PANEL;

VERMILION PARISH ONLY

AGES 21 - 64

804 NORTH MONCEAUX, KAPLAN

- 70548

(337)643-1525

1316415-001

KAPLAN TATE DAVID PHY FAMILY PRACTICE S 1 0 522 2500 AGES 0 - 64109 EAST FIFTH STREET,

KAPLAN - 70548

(337)643-8096

1093211-001

Page 110 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MAURICE MAURICE COMMUNITY CARE CLINIC RHC RURAL HEALTH

CLINIC

S 5 1 315 3000 AGES 2 - 64207 MILTON ROAD, MAURICE -

70555

(337)898-9449

1012050-001

AYMOND, CHER, MD - 1420085

BOUDREAUX, MANDY, MD - 1706639

HARRINGTON, MELISA, MD - 1042196

MEEKS, CLAUDE, MD - 1075795

PELLERIN, JR, GILBERT, MD - 1045675

RATLIFF, JULIE, NP - 1127621

Page 111 of 233



4REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ACADIA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

4

2

6

2

2

0

1

0

3

2

11

3

2

0

0

0

TOTAL 17 21 4 23,059 11,683 11,941

EVANGELINE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

5

3

6

1

0

0

1

2

5

4

6

1

0

0

1

TOTAL 18 19 1 24,349 7,688 7,838

Page 112 of 233



4REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

IBERIA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

6

2

10

3

0

1

3

0

19

3

14

6

0

0

0

2

TOTAL 25 44 4 50,461 15,006 15,412

LAFAYETTE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

16

6

11

1

1

0

0

0

33

15

15

5

1

0

0

4

TOTAL 35 73 4 82,319 27,596 28,217

Page 113 of 233



4REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ST. LANDRY

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

9

6

12

1

1

1

2

0

11

6

18

4

3

0

0

2

TOTAL 32 44 8 55,862 20,403 20,760

ST. MARTIN

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

0

2

0

0

1

1

0

5

1

2

0

1

0

0

2

TOTAL 5 11 3 10,439 9,065 9,261

Page 114 of 233



4REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

VERMILION

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

4

1

3

0

0

1

3

1

7

1

9

1

4

0

0

3

TOTAL 13 25 4 31,550 9,022 9,216

Page 115 of 233



REGION 4

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 42

22

2

10

4

5

13

47

14

0

0

12

25

33

80

73

TOTAL 145 237 28 278,039 100,463 102,645

Page 116 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ALLEN

ELIZABETH ELIZABETH FAMILY HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 0 1 183 1000 AGES 0 - 64504 WEST MAIN STREET,

ELIZABETH - 70638

(318)634-5475

1456365-001

EAVES, MICA, NP - 1722201

KINDER ALLEMAND PEGGY PHY FAMILY PRACTICE K 1 0 131 131 CURRENT PATIENTS &

SIBLINGS AGES 0 - 64208 6TH AVENUE, SUITE 5,

KINDER - 70648

(337)738-2713

1338231-001

KINDER ALLEN PARISH HOSPITAL RURAL

HEALTH CLINIC

RHC RURAL HEALTH

CLINIC

K 2 1 1153 5500 AGES 0 - 64108 6TH AVENUE, KINDER - 70648

(337)738-9494

1454842-001

BORDENAVE, BARRY, MD - 1163007

RHODES, REBECCA, NP - 1124419

UGHOVWA, EJIRO, MD - 1103985

OAKDALE DAVIS, JR. THOMAS PHY FAMILY PRACTICE K 1 0 159 159 CURRENT PATIENTS

AGES 0 - 64105 NORTH HOSPITAL DRIVE,

OAKDALE - 71463

(318)335-4321

1389081-001

OAKDALE GHANTA M. R. PHY FAMILY PRACTICE K 1 0 1508 2500 AGES 0 - 64115 HOSPITAL DRIVE, OAKDALE -

71463

(318)335-4393

1182630-001

OAKDALE OAKDALE FAMILY CARE PHY FAMILY PRACTICE S 2 0 743 5000 AGES 0 - 64400 EAST SIXTH STREET,

OAKDALE - 71463

(318)335-4881

1441660-001

BHARWANI, SUNIL, MD - 1071196

JEREZ, CATHY, MD - 1092240

Page 117 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



OBERLIN NAZIM MUHAMMAD PHY FAMILY PRACTICE S 1 0 38 2500 AGES 0 - 64616 COURT STREET, OBERLIN -

70655

(337)639-2500

1071218-001

BEAUREGARD

DERIDDER BONILLA EDWIN PHY FAMILY PRACTICE S 1 0 15 15 CLOSED PANEL403 WEST EIGHTH STREET,

DERIDDER - 70634

(337)463-8977

1913324-001

DERIDDER CARTER HENRY PHY INTERNAL MEDICINE 1 0 4 4 CLOSED PANEL305 WEST SEVENTH STREET,

SUITE C, DERIDDER - 70634

(337)463-4800

1020095-001

DERIDDER DOBBINS THOMAS PHY PEDIATRICS /

INTERNAL MEDICINE

K 1 0 860 2500 AGES 0 - 64; NO NEW

PATIENTS OVER AGE 1325 WEST EIGHTH STREET,

DERIDDER - 70634

(337)463-3387

1483893-001

DERIDDER DUPLECHAIN RANDALL PHY FAMILY PRACTICE S 1 0 163 163 CURRENT PATIENTS

AGES 0 - 64701 SOUTH PINE STREET,

DERIDDER - 70634

(337)462-1080

1337404-001

DERIDDER GRANGER CHRISTOPHER PHY GENERAL PRACTICE S 1 0 85 85 CLOSED PANEL403 WEST EIGHTH STREET,

DERIDDER - 70634

(337)463-8977

1627062-001

Page 118 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



DERIDDER GRIFFIN THOMAS PHY PEDIATRICS S 1 0 1348 1348 OPEN AGES 0 - 12

MONTHS ; CURRENT PTS

AGES 1 - 18

200 WEST FIFTH STREET,

DERIDDER - 70634

(337)463-3176

1152871-001

DERIDDER PANDYA MAHESH PHY INTERNAL MEDICINE 1 0 3 3 CURRENT PATIENTS

AGES 21 - 64603 SOUTH PINE STREET,

DERIDDER - 70634

(337)463-2172

1320692-001

DERIDDER PERKINS MICHAEL PHY PEDIATRICS K 1 0 1769 2500 AGES 0 - 20; ACCEPTING

NEW PTS AGES 0 - 17

ONLY

813 BON AMI STREET, DERIDDER

- 70634

(337)462-6000

1181137-001

DERIDDER TAYLOR FLYNN PHY FAMILY PRACTICE S 1 0 392 392 CLOSED PANEL412 SOUTH PINE STREET,

DERIDDER - 70634

(337)463-9890

1186384-001

CALCASIEU

DEQUINCY ADAMSON FATAI PHY PEDIATRICS K 1 0 643 2500 AGES 0 - 20128 WEST FOURTH STREET,

DEQUINCY - 70633

(337)786-3913

1583481-001

DEQUINCY CHADHA MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 903 5500 AGES 0 - 64140 WEST FOURTH STREET,

DEQUINCY - 70633

(337)786-5007

1456128-001

BOUDREAUX, MARCUS, NP - 1191078

CHADHA, JAGJIT, MD - 1555070

CHADHA, NANDITA, MD - 1559024

Page 119 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



DEQUINCY DEQUINCY MEDICAL CLINIC, LLC PHY INTERNAL MEDICINE K 2 0 532 5000 AGES 6 - 64601 WEST FOURTH STREET,

DEQUINCY - 70633

(337)786-6161

1445347-001

ABBARA, MAHER, MD - 1476196

JOUDEH, JALAL, MD - 1653811

DEQUINCY JACOBS ERIC PHY FAMILY PRACTICE K 1 0 513 2500 AGES 0 - 64122 WEST FOURTH STREET,

DEQUINCY - 70633

(337)786-3030

1921718-001

IOWA IOWA HEALTH CENTER RHC RURAL HEALTH

CLINIC

K 1 1 483 3000 ONLY RESIDENTS OF

CALCASIEU&JEFFDAVIS

PAR AGES3-21

203 EAST MILLER, SUITE B, IOWA

- 70647

(337)582-7632

1946249-001

KOHATSU, JORGE, MD - 1534943

WHITEHEAD, KAREN, NP - 1777641

LAKE CHARLES ADEOSUN ANTHONY PHY FAMILY PRACTICE S 1 0 499 2500 AGES 0 - 64333 SOUTH RYAN STREET, SUITE

120, LAKE CHARLES - 70601

(337)493-8480

1638820-001

LAKE CHARLES BERGSTEDT JENNETTE PHY PEDIATRICS K 1 0 404 404 CLOSED PANEL4150 NELSON ROAD BUILDING E,

SUITE 1, LAKE CHARLES - 70605

(337)474-2933

1655724-001

LAKE CHARLES BREAUX ADRIENNE PHY INTERNAL MEDICINE K 1 0 230 230 OPEN BIRTH TO 1MO;

CURR PTS & SIBLINGS

AGES 2M-18Y

711 SOUTH RYAN STREET, SUITE


(337)491-7072

1016284-001

Page 120 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LAKE CHARLES BROUSSARD YANG-TZE PHY INTERNAL MEDICINE K 1 0 272 272 CURRENT PATIENTS

AGES 0 - 18711 SOUTH RYAN STREET, LAKE

CHARLES - 70601

(337)439-2200

1483320-001

LAKE CHARLES CHATTERS RACHEL PHY PEDIATRICS K 1 0 1930 1930 0 - 2 MTHS; 3 MTHS - 18

CURRENT PTS & PREM

BABIES

1935 SOUTHWOOD DRIVE, LAKE

CHARLES - 70605

(337)475-9009

1483567-001

LAKE CHARLES CHILDREN'S CLINIC OF SOUTHWEST

LOUISIANA


AGES 0 - 202903 FIRST AVENUE, LAKE

CHARLES - 70601

(337)478-6480

1797995-001

BOWMAN, MISTY, NP - 1021431

DECKER, DEBORAH, MD - 1490857

KARPOVS, ANATOLE, MD - 1625591

KARRIKER, BRYAN, MD - 1491594

KORDISCH, JR., FOSTER, MD - 1140457

LANDRY, STUART, MD - 1901091

MAUST - II, JAY, MD - 1539988

MCCANLESS, EDGAR, MD - 1065897

MURRAY, ELIZABETH, MD - 1074951

SAVOIE, BETH, NP - 1568121

SUMRALL, MICHELLE, MD - 1091120

THOMPSON, BRUCE, MD - 1314277

WALLACE, DAVID, MD - 1329762

LAKE CHARLES FAMILY MEDICAL CENTER LTD PHY FAMILY PRACTICE 5 0 7 7 CLOSED PANEL2750 ASTER STREET, LAKE

CHARLES - 70601

(337)478-2650

1126730-001

BOYER, SYLVIA, MD - 1170607

DOBBINS, DAVID, MD - 1301965

HUTCHINSON, CAROLYN, MD - 1048666

KANE, PERCIVAL, MD - 1306746

SEEP, MICHAEL, MD - 1347876

Page 121 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LAKE CHARLES JONES SUSAN PHY INTERNAL MEDICINE 1 0 48 48 CURRENT PATIENTS

AGES 21 - 642708 SECOND AVENUE, SUITE C,

LAKE CHARLES - 70601

(337)474-0046

1921564-001

LAKE CHARLES LSUMC - S FAMILY PRACTICE CENTER PHY FAMILY PRACTICE K 9 1 907 907 OPEN AGES 0 - 18; CURR

PTS AGES 19 - 64 & OB

PTS

1525 OAK PARK BOULEVARD,


(337)494-6767

1947865-001

BAROOTES, BRYAN, MD - 1429155

CONNER, PHILLIP, MD - 1571229

DAWSON, MARK, MD - 1197823

DOBBINS, DAVID, MD - 1301965

HUMPHRIES, CHARLES, MD - 1571482

HUTCHINSON, CAROLYN, MD - 1048666

LEBATO, ALAN, MD - 1347078

LOEWER, BRADLEY, NP - 1066273

PRIMEAUX, ARTHUR, MD - 1306932

SOILEAU, JR., EARL, MD - 1341690

LAKE CHARLES MCLURKIN DANIELLE PHY FAMILY PRACTICE K 1 0 1371 2500 AGES 0 - 641403 OAK PARK BOULEVARD,


(337)491-1009

1162965-001

LAKE CHARLES PEDIATRIC CENTER OF SOUTHWEST

LOUISIANA, THE (site 002)

PHY PEDIATRICS K 1 1 70 70 OPEN 0 - 15; CURRENT

PTS AGES 16 - 641920 WEST SALE ROAD, SUITE

F7, LAKE CHARLES - 70605

(337)477-0935

1948195-002

RODGERS, ALYCIA, MD - 1190730

VINCENT, DEBRA, NP - 1532690

Page 122 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LAKE CHARLES PRIMARY CARE CLINIC - W. O. MOSS PHY INTERNAL MEDICINE S 5 0 1059 12500 AGES 14 - 641000 WALTERS STREET, LAKE

CHARLES - 70607

(337)475-8066

1948926-001

BENIPAL, HARPAL, MD - 1696803

KHAN, TARIQ, MD - 1670936

LIE, PING - KOK, MD - 1997072

SARWAR, MOHAMMED, MD - 1681261

SHAIKH, MUHAMMAD, MD - 1696790

LAKE CHARLES ROSS CARL PHY GENERAL PRACTICE 1 0 414 2500 AGES 21 - 64410 LOUISIANA AVENUE, LAKE

CHARLES - 70601

(337)439-4923

1314111-001

LAKE CHARLES ROY ANAND PHY INTERNAL MEDICINE S 1 0 73 73 CLOSED PANEL760 EAST BAYOU PINES, LAKE

CHARLES - 70601

(337)433-0313

1989614-001

LAKE CHARLES SANDERS RICHARD PHY FAMILY PRACTICE S 1 0 597 2500 AGES 0 - 64; ACCEPTING

NEW PTS AGES 0 - 20

ONLY

277 HIGHWAY 171 NORTH, SUITE


(337)312-0030

1199711-001

Page 123 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LAKE CHARLES SWLA CENTER FOR HEALTH SERVICES FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 9 2 3735 16000 AGES 0 - 642000 OPELOUSAS STREET, LAKE

CHARLES - 70601

(337)439-9983

1940828-001

AUSTIN, JAMES, MD - 1112186

BROWNING, LILLIAN, NP - 1686549

COLLIGAN, JOHN, MD - 1121878

FERNANDEZ - MALDONADO, ANNA, MD - 1689921

FONTENOT, CRYSTAL, NP - 1911640

GREEN, HILMA, MD - 1018953

KORDISCH, STANLEY, MD - 1303160

MCKINNEY - HAWKINS, GISELE, MD - 1627321

SAQER, GHADA, MD - 1066290

VARGHESE, LESLY, MD - 1092363

VAUGHN, LISA, DO - 1301710

LAKE CHARLES WO MOSS REGIONAL MEDICAL - PEDS PHY PEDIATRICS K 2 0 1169 2500 AGES 0 - 131000 WALTERS STREET, LAKE

CHARLES - 70607

(337)475-8420

1449415-001

PARAGUYA, LUZVIMINDA, MD - 1300357

UNKEL, PATRICK, MD - 1067202

SULPHUR MAGNOLIA CLINIC, THE PHY FAMILY PRACTICE K 0 2 805 805 CURRENT PATIENTS,


AGES 0 - 20

914 SOUTH POST OAK ROAD,

SULPHUR - 70663

(337)625-0035

1440639-001

BOUDREAUX, MARCUS, NP - 1191078

DUHON, SUSAN, NP - 1955981

SULPHUR PEDIATRIC CENTER OF SOUTHWEST

LOUISIANA, THE (site 001)

PHY PEDIATRICS K 4 1 4675 4675 OPEN AGES 0 - 16;


20

600 CYPRESS STREET, SULPHUR

- 70663

(337)527-6371

1948195-001

BABINEAUX, JULIE, MD - 1079162

RICHERT, ALBERT, MD - 1135534

RICHERT, JR., ALBERT, MD - 1193488

THOMAS, JENNY, MD - 1626678

VINCENT, DEBRA, NP - 1532690

Page 124 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



VINTON VINTON MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 2 3 257 1000 AGES 0 - 641611 HAMPTON STREET, VINTON

- 70668

(337)589-5951

1452785-001

BREWER, RUTH, NP - 1692450

NGUYEN, DANG, MD - 1066281

THOMAS, KEN, MD - 1787159

WALDMEIER, LANCE, NP - 1439681

WALDMEIER, VALARIE, NP - 1438359

WESTLAKE FAMILY CARE CENTER OF SWLA, THE PHY PEDIATRICS K 2 1 117 125 LIMITED PANEL; AGES 0 -

18; CURR PTS AGES 19 -

64

2345 SAMPSON STREET,

WESTLAKE - 70669

(337)439-1484

1021571-001

FLYNT, JANE, NP - 1535958

GEORGE, JODY, MD - 1073750

HUTSON, BRENT, MD - 1073768

CAMERON

HACKBERRY HACKBERRY RURAL HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 1 3 170 1000 AGES 0 - 641020 MAIN STREET, HACKBERRY

- 70645

(337)762-3762

1945251-001

BREWER, RUTH, NP - 1692450

GALLEY, JULIE, NP - 1537730

SCHLAMP, KEVIN, MD - 1992411

WALDMEIER, VALERIE, NP - 1438359

LAKE CHARLES SOUTH CAMERON MEMORIAL

HOSPITAL

RHC RURAL HEALTH

CLINIC

B 1 1 309 1000 AGES 0 - 6410080 GULF HIGHWAY, LAKE

CHARLES - 70607

(337)905-4111

1944335-001

CHEVALLIER, LINDA, NP - 1666963

HOLLEN, JAKE, MD - 1373150

JEFFERSON DAVIS

Page 125 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ELTON ELTON RURAL HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 1 2 505 2500 AGES 0 - 64907 MAIN STREET, ELTON - 70532

(337)584-2237

1947920-001

LEBLANC, LARRY, MD - 1362476

SONNIER, MICHAEL, NP - 1464589

VIDRINE, DEBRA, NP - 1477532

JENNINGS APELLANIZ LUIS PHY PEDIATRICS B 1 0 1582 2500 AGES 0 - 211636 ELTON ROAD, SUITE 204,

JENNINGS - 70546

(337)824-3446

1908762-001

JENNINGS CLAWSON MARK PHY FAMILY PRACTICE B 1 0 729 729 CURRENT PATIENTS &

FAMILY MEMBERS AGES

0 - 64

805 NORTH STATE STREET,

JENNINGS - 70546

(337)824-8099

1900249-001

JENNINGS JEFFERSON DAVIS FAMILY MEDICINE

APMC

PHY FAMILY PRACTICE K 3 0 671 671 CURRENT PATIETNS

AGES 0 - 641322 ELTON ROAD, SUITE D,

JENNINGS - 70546

(337)824-1111

1445151-001

ACHEE, CHRISTOPHER, MD - 1422771

BENOIT, MICHAEL, MD - 1422827

MCNALLY, JAMES, MD - 1423297

JENNINGS LACOMB FAMILY MEDICINE PHY FAMILY PRACTICE K 2 1 1240 5500 AGES 0 - 64; ACCEPTING

NEW PTS AGES 0 - 17

ONLY

1322 ELTON HIGHWAY, SUITE F,

JENNINGS - 70546

(337)824-8868

1446521-001

FONTANEZ, MARIA, MD - 1908711

LACOMB, AMANDA, MD - 1491667

NEIDIGH, TIM, NP - 1167274

LAKE ARTHUR LAKE ARTHUR HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 0 2 206 206 CLOSED PANEL328 KELLOGG STREET, LAKE

ARTHUR - 70549

(337)774-0100

1442488-001

DARBONNE, CONSTANCE, NP - 1431842

MONELEZUM, TINA, NP - 1182826

Page 126 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



WELSH KANG YOUNG PHY GENERAL PRACTICE B 1 0 451 2500 AGES 0 - 64111 SOUTH ADAMS, WELSH -

70591

(337)734-4730

1300691-001

WELSH KRIELOW YVONNE NP NURSE

PRACTITIONER

K 0 1 401 401 CURRENT PATIENTS &

SIBLINGS AGES 0 - 64708 EAST RUSSELL, WELSH -

70591

(337)734-4500

1141046-001

WELSH WELSH FAMILY PRACTICE PHY FAMILY PRACTICE /

INTERNAL MEDICINE

K 0 1 349 500 AGES 0 - 64308 SOUTH PALMER, WELSH -

70591

(337)734-4901

1444758-001

MURRAY, KELLY, NP - 1149837

Page 127 of 233



5REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ALLEN

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

5

0

0

0

2

0

1

1

6

0

0

0

0

0

TOTAL 7 8 2 16,790 4,101 4,193

BEAUREGARD

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

3

2

3

1

0

0

0

0

3

2

3

1

0

0

0

0

TOTAL 9 9 0 7,010 5,318 5,463

Page 128 of 233



5REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

CALCASIEU

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

8

6

7

1

0

1

3

0

22

11

26

3

4

0

0

1

TOTAL 26 67 15 79,083 29,831 30,475

CAMERON

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

0

0

0

2

0

0

0

0

2

0

0

0

0

TOTAL 2 2 4 2,000 366 374

Page 129 of 233



5REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

JEFFERSON DAVIS

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

0

4

1

0

0

2

1

3

0

4

2

0

0

0

0

TOTAL 9 9 7 15,507 5,404 5,517

Page 130 of 233



REGION 5

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 12

8

1

9

1

0

3

19

1

0

0

4

8

14

29

39

TOTAL 53 95 28 120,390 45,020 46,022

Page 131 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



AVOYELLES

BUNKIE BUNKIE GEN HOSP FAMILY CARE

CLINIC

RHC RURAL HEALTH

CLINIC

K 1 1 990 3000 AGES 0 - 64510 SOUTH COTTONWOOD

STREET, BUNKIE - 71322

(318)346-3339

1452637-001

JUNEAU, JANELLE, NP - 1507121

LAVERGNE, BLAINE, MD - 1650790

BUNKIE BUNKIE GENERAL HOSPITAL RURAL

HEALTH CLINIC

RHC RURAL HEALTH

CLINIC

S 2 1 744 3000 AGES 0 - 64109 NORTH LEXINGTON AVENUE,

BUNKIE - 71322

(318)346-7283

1943762-001

HINES, DONALD, MD - 1064815

HOOD, MARY TEMPLE, NP - 1437816

SRIVASTAVA, MOHIT, MD - 1460788

COTTONPORT COTTONPORT FAMILY CLINIC RHC RURAL HEALTH

CLINIC

K 1 3 1628 2000 AGES 0 - 64912 BRYAN STREET,

COTTONPORT - 71327

(318)876-3696

1448575-001

DEVILLE - ARDOIN, DANA, NP - 1479390

GAUTHIER, JR, NEWELL, MD - 1127035

JEANSONNE, HERNDON, NP - 1306371

NEWMAN, TAMATHA, NP - 1469637

MANSURA MANSURA FAMILY CLINIC RHC RURAL HEALTH

CLINIC

K 1 2 120 1000 AGES 0 - 642104 CLECO STREET, MANSURA -

71350

(318)964-2551

1019828-001


JEANSONNE, II, HERNDON, NP - 1306371


MARKSVILLE GAGIC PREDRAG PHY GENERAL SURGERY 1 0 5 5 CURRENT PATIENTS

AGES 21 - 64313 CENTER STREET,

MARKSVILLE - 71351

(318)253-8655

1304841-001

Page 132 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MARKSVILLE GOUX VINCENT PHY FAMILY PRACTICE S 1 0 267 267 CLOSED PANEL597 TUNICA DRIVE, MARKSVILLE

- 71351

(318)253-7511

1454036-001

MARKSVILLE MARKSVILLE FAMILY CARE CENTER RHC RURAL HEALTH

CLINIC

K 4 2 2397 3500 AGES 0 - 645541 HIGHWAY 1, MARKSVILLE -

71351

(318)240-7240

1947130-001

BROUILLETTE, BEAU, MD - 1571091

COUTEE, CLARA, NP - 1693073

DAUZAT, WENDY, NP - 1013218

GARCIA, FERNANDO, MD - 1319911

KALIFEY, EDMOND, MD - 1062791

PLAUCHE, WARREN, MD - 1378976

MARKSVILLE MCCANN DARRON PHY FAMILY PRACTICE S 1 0 416 416 NEW PTS AGES 0 - 20;

CURRENT PATIENTS

AGES 21 - 64

424 NORTH WASHINGTON

STREET, MARKSVILLE - 71351

(318)253-1788

1487155-001

MARKSVILLE MCCANN SHAWN PHY FAMILY PRACTICE S 1 0 313 2500 AGES 0 - 64; ACCEPTS

AGES 0 - 18 ONLY424 NORTH WASHINGTON

STREET, SUITE C, MARKSVILLE -

71351(318)240-9503

1582816-001

MARKSVILLE MOUNAYAR ELIAS PHY INTERNAL MEDICINE S 1 0 102 2500 AGES 0 - 644239 HIGHWAY 1192, SUITE100,

MARKSVILLE - 71351

(318)253-5600

1471771-001

Page 133 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



SIMMESPORT KD HEALTH & WELLNESS CENTER RHC RURAL HEALTH

CLINIC

K 1 3 179 2000 AGES 0 - 64118 JJJ LANE, SIMMESPORT -

71369

(318)941-5286

1131041-001

BERTRAND, KELLIE, NP - 1174882


NEWTON, DEDRA, NP - 1477761

PERRAULT, STACEY, NP - 1478831

SIMMESPORT KUPLESKY STEPHEN PHY GENERAL PRACTICE K 1 0 308 2500 AGES 0 - 64314 CHRISTINE LANE,

SIMMESPORT - 71369

(318)941-2057

1138258-001

SIMMESPORT SIMMESPORT FAMILY CLINIC RHC RURAL HEALTH

CLINIC

K 2 3 862 1000 AGES 0 - 64417 NORTH MARTIN LUTHER

KING DRIVE, SIMMESPORT -

71369(318)941-2336

1448648-001

DEVILLE - ARDOIN, DANA, NP - 1479390



JEANSONNE, HERNDON, NP - 1306371


CATAHOULA

JONESVILLE CONEY WILLLIAM PHY FAMILY PRACTICE S 1 0 305 2500 AGES 6 MONTHS - 64

YEARS904 FIRST STREET, JONESVILLE -

71343

(318)339-8387

1106488-001

JONESVILLE LASALLE PRIMARY HEALTHCARE

CENTER

RHC RURAL HEALTH

CLINIC

K 2 1 675 2500 AGES 0 - 642801 4TH STREET, SUITE 5,

JONESVILLE - 71343

(318)339-9990

1449717-001

AHMED, TARIQ, MD - 1533661

NGUYEN, LILY DIEP NGOC, PA - 1012815

TAPIA, JORGE, MD - 1436747

Page 134 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



JONESVILLE RIVERPARK MEDICAL CLINIC -

JONESVILLE

RHC RURAL HEALTH

CLINIC

K 2 1 393 1000 AGES 0 - 64800 AUDUBON DRIVE,

JONESVILLE - 71343

(318)339-4112

1447498-001

DAVIS, SUSAN, NP - 1623814

TILLMAN, BARRY, MD - 1371483

TILLMAN, CLIFFORD, MD - 1316521

SICILY ISLAND CATAHOULA PARISH HOSPITAL DIST. 2 FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 3 431 2000 AGES 0 - 64307 CHISUM STREET, SICILY

ISLAND - 71368

(318)389-5727

1940801-001

ARNOLD, HUGH, NP - 1560171

GRAY, CYNTHIA, NP - 1378127

PORTER, MARY ELLEN, NP - 1469785

TRUNZLER, BASIL, MD - 1104221

CONCORDIA

FERRIDAY BONOMO CARRIE PHY PEDIATRICS K 1 0 926 2500 AGES 0 - 171810 EE WALLACE BOULEVARD,

SUITE 5, FERRIDAY - 71334

(318)757-3006

1160059-001

FERRIDAY CONCORDIA COMMUNITY HEALTH

CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

S 2 2 240 2500 AGES 0 - 641810 EE WALLACE BOULEVARD,

FERRIDAY - 71334

(318)757-6969

1448371-001


IQBAL, ATHER, MD - 1529435

PORTER, MARY, NP - 1469785


FERRIDAY GREMILLION MAURICE PHY FAMILY PRACTICE S 1 0 230 230 CURRENT PATIENTS &

SIBLINGS AGES 0 - 64200 SERIO BOULEVARD,

FERRIDAY - 71334

(318)757-2000

1138967-001

Page 135 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



FERRIDAY LEE SARAH PHY FAMILY PRACTICE K 1 0 408 2500 AGES 0 - 64100 LINCOLN AVENUE, FERRIDAY

- 71334

(318)757-7000

1395269-001

FERRIDAY MOAK HUEY PHY FAMILY PRACTICE S 1 0 382 382 CURRENT PATIENTS

AGES 6 MONTHS - 64

YEARS

112 SERIO BOULEVARD,

FERRIDAY - 71334

(318)757-3696

1360198-001

VIDALIA INGRAM JOHNNY PHY FAMILY PRACTICE S 1 0 312 2500 AGES 0 - 641806 CARTER STREET, VIDALIA -

71373

(318)336-8166

1066435-001

VIDALIA PEDIATRIC AND ADOLESCENT CLINIC RHC RURAL HEALTH

CLINIC

K 1 1 1030 1000 AGES 0 - 20205 CARTER STREET, VIDALIA -

71373

(318)336-7172

1021849-001

BALLARD, DEANNA, NP - 1529052

TIMM, DAVID, MD - 1349011

GRANT

COLFAX CENLA RURAL HEALTH CENTERS RHC RURAL HEALTH

CLINIC

K 1 1 592 1000 AGES 0 - 64340 WEBB SMITH DRIVE, COLFAX

- 71417

(318)627-3700

1448524-001

FINN, DEBBIE, NP - 1149691

PILAND, SR., JAY, MD - 1497576

POLLOCK CRAIG BRUCE PHY GENERAL PRACTICE S 1 0 949 2500 AGES 0 - 643819 PATTERSON STREET,

POLLOCK - 71467

(318)765-3750

1162736-001

LASALLE

Page 136 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



JENA AHMED TARIQ PHY PEDIATRICS K 1 0 766 2500 AGES 0 - 20121 9TH STREET HIGHWAY 84,

JENA - 71342

(318)992-9296

1533661-001

JENA CHAUDHRY RIAZ PHY INTERNAL MEDICINE S 1 0 233 2500 AGES 0 - 6411809 HIGHWAY 84 WEST, JENA -

71342

(318)992-4133

1170623-001

JENA KENDRICK ROBERT PHY FAMILY PRACTICE S 1 0 55 2500 AGES 2 - 64155 NINTH STREET, JENA - 71342

(318)992-4275

1191825-001

JENA TURNLEY IDOLPHUS PHY GENERAL PRACTICE S 1 0 149 2500 AGES 0 - 642510 NORTH FIRST STREET,

JENA - 71342

(318)992-2166

1021172-001

OLLA HARDTNER MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 3 1 671 5500 AGES 0 - 641136 A NORTH PINE ROAD, OLLA

- 71465

(318)495-3880

1449342-001

BENJAMIN, MARY, NP - 1113549

ROWDEN, PHILLIP, MD - 1335215

SMITH, BRIAN, MD - 1629014

TANITA, JEFFREY, MD - 1054356

RAPIDES

Page 137 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ALEXANDRIA CENLA CHILDRENS CLINIC &

ASSOCIATES

PHY PEDIATRICS K 2 2 517 517 CURRENT PATIENTS,

SIBLINGS, & NEWBORNS

AGES 0 - 20

501 MEDICAL CENTER DRIVE,

SUITE 100, ALEXANDRIA - 71301

(318)487-1358

1008052-001

DANIVAS, ANIL, MD - 1682152

DELCAMBRE, REBECCA, NP - 1016403

PAUL, RHONDA, NP - 1453323

REDDY, C. V., MD - 1196371

ALEXANDRIA CRAIG BRUCE PHY GENERAL PRACTICE S 1 0 1122 2500 AGES 0 - 642913 LEE STREET, ALEXANDRIA -

71301

(318)445-6200

1162736-002

ALEXANDRIA CULPEPPER ROBERT PHY PEDIATRICS S 1 0 595 2500 AGES 0 - 203916 JACKSON STREET,

ALEXANDRIA - 71303

(318)487-9860

1051144-001

ALEXANDRIA FAMILY MEDICINE CENTER PHY FAMILY PRACTICE S 3 0 193 193 CLOSED PANEL2108 TEXAS AVENUE, SUITE

3080, ALEXANDRIA - 71301

(318)442-5758

1445266-001

JOINER, CHARLES, MD - 1321559

MILDER, PETER, MD - 1979201

PEREZ, ALEJANDRO, MD - 1974226

ALEXANDRIA HAYS RONALD PHY INTERNAL MEDICINE 1 0 21 21 CLOSED PANEL201 4TH STREET, ALEXANDRIA -

71301

(318)448-1249

1987875-001

Page 138 of 233


REGION


CAP.

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CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ALEXANDRIA HPL FAMILY MEDICINE CLINICS PHY GENERAL PRACTICE S 10 0 614 5000 AGES 18 - 642351 VANDENBURG DRIVE,

ALEXANDRIA - 71303

(318)473-6271

1018082-001

BANKS, DANIEL, MD - 1436089

BARNARD, DAVID, MD - 1185744

BASS, III, PAT, MD - 1493686

FORT, III, ARTHUR, MD - 1145793

HARPER, MICHAEL, MD - 1311456

HARRIS, JEFFREY, MD - 1071382

HEARD, FREDERICK, MD - 1995118

ISHERWOOD, PHILIP, MD - 1423131

NELSON, DAVID, MD - 1699179

ROBERTS, RUSSELL, MD - 1199168

ALEXANDRIA HPL PEDIATRIC CLINIC PHY PEDIATRICS S 4 0 2325 5000 AGES 0 - 202351 VANDENBURG DRIVE,

ALEXANDRIA - 71303

(318)473-6271

1018082-002

BARNARD, DAVID, MD - 1185744

KANESAN, KRISHNAKUMA, MD - 1060011

KELLY, JR, ERNEST, MD - 1340146

NAKHLAWI, YASSER, MD - 1567906

Page 139 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ALEXANDRIA LSUMC - S FAMILY PRACTICE

MEDICINE

PHY FAMILY PRACTICE K 17 0 1632 1632 OPEN AGES 0 - 18;


64

821 ELLIOTT STREET,

ALEXANDRIA - 71301

(318)441-1030

1948705-001

BALAPALA, KIRANMAYE, MD - 1071188

BUCK, MICHAEL, MD - 1318469

ELKINS, BRIAN, MD - 1556793

ELLERBE, WILLIAM, MD - 1092169

ERTAN, TUNCAY, MD - 1109533

GUILLOT, HEATHER, MD - 1053236

HOLTON, J. CAROLE, MD - 1486884

JOBE, BRIAN, MD - 1675971

MADDEN, MICHAEL, MD - 1102440

MOORE, ROBERT, MD - 1359505

NORWOOD, CHARLES, MD - 1155691

PHILLIPS, NATALIE, MD - 1578690

PINFOLD, ANNE, MD - 1557676

PINFOLD, ANNE, MD - 1557676

SLAUGHTER, CLOIS, MD - 1684350

TOUCHET, BRADLEY, MD - 1152781

VERMA, RAJINDER, MD - 1326470

ALEXANDRIA MALLORY VINCENT PHY FAMILY PRACTICE 1 0 1 1 CLOSED PANEL3311 PRESCOTT ROAD, SUITE

316, ALEXANDRIA - 71301

(318)487-1717

1574520-001

ALEXANDRIA MANSOOR PEDIATRICS PHY PEDIATRICS K 3 4 5978 8500 AGES 0 - 20501 MEDICAL CENTER DRIVE,

SUITE 3A, ALEXANDRIA - 71301

(318)484-3899

1445215-001

DUPLECHIEN, ERIN, NP - 1156850

GORE, ANGELA, NP - 1454877

MANSOOR, SHAHID, MD - 1435350

MCKNIGHT, CELESTE, NP - 1470031

MITCHELL, MARCIA, MD - 1192228

TAUSEEF, MUHAMMAD, MD - 1177784

WEIR, ROBIN, NP - 1314579

Page 140 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ALEXANDRIA MANUEL MICHAEL PHY PEDIATRICS S 1 0 383 400 LIMITED PANEL;

CURRENT PTS AND

SIBLINGS AGES 0 - 1

301 4TH STREET, ALEXANDRIA -

71301

(318)473-4632

1160741-001

ALEXANDRIA MOORE ROBERT PHY FAMILY PRACTICE S 1 0 N/A CLOSED PANEL225 PECAN PARK AVENUE,

ALEXANDRIA - 71303

(318)442-1002

1359505-001

ALEXANDRIA PRIMARY CARE SPECIALISTS PHY FAMILY PRACTICE S 2 0 76 76 CLOSED PANEL3802 PRESCOTT ROAD,

ALEXANDRIA - 71301

(318)487-6060

1448699-001

BAKER, SHARIFA, MD - 1577880

BEVELS, GREGORY, MD - 1577910

ALEXANDRIA RAPIDES PRIMARY HEALTH CARE

CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 4 0 2646 7500 AGES 0 - 641217 WILLOW GLEN RIVER ROAD,

ALEXANDRIA - 71302

(318)487-4400

1443751-001

DICKEY, RHONDA, MD - 1013099

DUGAN, ERIC, MD - 1466476

PILATOVA, RENATA, MD - 1662721

ZAVALETA, JOSE, MD - 1496065

ALEXANDRIA RHODES PEDIATRIC CLINIC PHY PEDIATRICS S 2 1 154 154 CURRENT PATIENTS AND

SIBLINGS AGES 0 - 2037 CALVERT DRIVE, ALEXANDRIA

- 71303

(318)443-9634

1441236-001

CREWS, ROSLYN, NP - 1116475

MARZULLO, MICHAEL, MD - 1491926

RHODES, JOHN, MD - 1902268

ALEXANDRIA SOUTHERN PEDIATRIC CLINIC PHY PEDIATRICS K 2 0 2986 5000 AGES 0 - 201416 METRO DRIVE, ALEXANDRIA

- 71303

(318)561-4200

1449237-001

CHINAGOZI, SONJI, MD - 1612316

GWANDIKU - AMBE, STELLA, MD - 1545414

Page 141 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ALEXANDRIA TULANE HP LONG OBSTETRICS PHY OBGYN S 2 0 244 5000 FEMALES ONLY, AGES 12

- 642351 VANDENBURG DRIVE,

ALEXANDRIA - 71303

(318)483-7122

1443271-001

MAY, JONATHAN, MD - 193299

YANG, LILY, MD - 1683001

LECOMPTE CENLA FAMILY MEDICAL CENTER PHY FAMILY PRACTICE K 1 3 1056 3000 AGES 0 - 64; ACCEPTING

PATIENTS AGES 0 - 18

ONLY

1610 WATER STREET,

LECOMPTE - 71346

(318)776-9340

1441899-001

DUGAS, ROBBIE, NP - 1690732

PELUSO, JESSICA, PA - 1888702

SLAUGHTER, CLOIS, MD - 1684350

VOELKER, CAROLYN, NP - 1040002

PINEVILLE CENLA CHILDREN'S CLINIC &

ASSOCIATES

PHY PEDIATRICS S 1 2 980 980 CURRENT PATIENTS,

SIBLINGS, & NEWBORNS

AGES 0 - 20

101 MEDICAL PARK BOULEVARD,

SUITE A, PINEVILLE - 71360

(318)561-0252

1008052-002

BHARGAVA, MANU, MD - 1435775

DELCAMBRE, REBECCA, NP - 1016403


PINEVILLE HEALTHY STEPS PEDIATRICS RHC RURAL HEALTH

CLINIC

K 2 1 1832 3000 AGES 0 - 17192 STILLEY ROAD, PINEVILLE -

71360

(318)484-3401

1125792-001

MANSOOR, SHAHID, MD - 1435350

TAUSEEF, MUHAMMAD, MD - 1177784

WEIR, ROBIN, NP - 1314579

PINEVILLE JOHNSON KENNETH PHY FAMILY PRACTICE 1 0 23 23 CURRENT PATIENTS

AGES 21 - 64101 MEDICAL PARK BOULEVARD,

SUITE C, PINEVILLE - 71360

(318)445-9538

1356280-001

Page 142 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



PINEVILLE PATEL NIRANJAN PHY PEDIATRICS K 1 0 1385 2500 AGES 0 - 643113 HIGHWAY 28 EAST, SUITE E,

PINEVILLE - 71360

(318)767-2222

1357588-001

PINEVILLE VERMA DEVINDER PHY INTERNAL MEDICINE 1 0 127 2500 AGES 21 - 646118 - B MONROE HIGHWAY,

PINEVILLE - 71360

(318)640-7366

1530603-001

WOODWORTH WOODWORTH FAMILY MED INC. RHC RURAL HEALTH

CLINIC

K 1 1 812 3000 AGES 0 - 649372 HIGHWAY 165 SOUTH,

WOODWORTH - 71485

(318)484-9588

1020184-001

BOSTICK - FIELD, KIMBERLY, NP - 1363189

GUILLOT, DAVID, MD - 1494437

STATE OF MISSISSIPPI

NATCHEZ NATCHEZ PEDIATRIC CLINIC PHY PEDIATRICS K 2 0 749 5000 AGES 0 - 20136 JEFFERSON DAVIS

BOULEVARD, SUITE A, NATCHEZ

- 39120(601)442-5439

1445967-001

RUSS, JENNIFER, MD - 1429074

WEARY, DANITA, MD - 1166138

NATCHEZ STRETCH T. BRIAN PHY PEDIATRICS K 1 0 326 2500 AGES 0 - 2055 SEARGENT PRENTISS DRIVE,

SUITE 7, NATCHEZ - 39120

(601)445-9543

1928291-001

VERNON

LEESVILLE ALAMMAR MEDICAL CLINIC, PLLC PHY INTERNAL MEDICINE B 1 0 347 2500 AGES 0 - 641760 SOUTH FIFTH STREET,

LEESVILLE - 71446

(337)238-5700

1447790-001

ALAMMAR, HUSSEIN, MD - 1995894

Page 143 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LEESVILLE BEG MIRZA PHY PEDIATRICS K 1 0 730 2500 AGES 0 - 20935 VERONE TERRACE, SUITE B,

LEESVILLE - 71446

(337)238-6952

1430498-001

LEESVILLE CROWE ROBERT PHY PEDIATRICS S 1 0 666 666 CURRENT PATIENTS AND

SIBLINGS AGES 0 - 20802 SOUTH 10TH STREET, SUITE

C, LEESVILLE - 71446

(337)239-2207

1584339-001

LEESVILLE DEER CREEK MEDICAL CENTER PHY GENERAL PRACTICE K 2 1 985 985 AGES 0 - 21; CURRENT

PATIENTS AGES 22 - 64301 WEST FERTITTA

BOULEVARD, LEESVILLE - 71446

(337)238-0167

1949477-001

CARLOCK, JENNIFER, NP - 1024643

LORD, GREGORY, MD - 1322750

MOREHOUSE, JANET, MD - 1360201

LEESVILLE KHATEEB NAILA PHY PEDIATRICS K 1 0 797 2500 AGES 0 - 401022 PORT ARTHUR TERRACE,

LEESVILLE - 71446

(337)238-9063

1550108-001

LEESVILLE LUBBOS MEDICAL CLINIC, INC. PHY INTERNAL MEDICINE S 2 0 16 16 CLOSED PANEL201 WEST ARKANSAS STREET,

LEESVILLE - 71446

(337)239-7227

1948870-001

LUBBOS, HANNA, MD - 1687324

SAIKALI, JOCELYNE, MD - 1124222

LEESVILLE MOLANI FAMILY PRACTICE CLINIC,

APMC

PHY FAMILY PRACTICE K 1 0 732 2500 AGES 0 - 64935 VERONE TERRACE,

LEESVILLE - 71446

(337)392-1545

1446581-001

FATIMA, JABEEN, MD - 1550663

Page 144 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LEESVILLE OUTPATIENT MEDICAL CENTER, INC. @

LEESVILLE

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 0 190 5000 AGES 0 - 641603 BOONE STREET, SUITE B,

LEESVILLE - 71446

(337)238-1274

1941026-001

SHEHATA, MOHAMED, MD - 1070769

SUDDALA, SATHEESH, MD - 1014346

LEESVILLE VO MEDICAL CLINIC, APMC PHY INTERNAL MEDICINE /

FAMILY PRACTICE

K 2 0 750 5000 AGES 0 - 641017 WEST FERTITTA

BOULEVARD, LEESVILLE - 71446

(337)239-2606

1449041-001

VO, LOI DAI, MD - 1663328

VO, THANH DAI, MD - 1056502

ROSEPINE BYRD MEDICAL CLINIC PHY INTERNAL MEDICINE K 3 0 363 7500 AGES 12 - 6418570 JOHNNY B. HALL ROAD,

ROSEPINE - 70659

(337)462-1913

1944718-002

DEAN - LLOYD ADAMS, PATVIN, MD - 1369519

MOSS, MELISSA, MD - 1490067

TON, ARIEL, MD - 1054372

WINN

WINNFIELD COLLIER L. R. PHY GENERAL SURGERY 1 0 99 100 LIMITED PANEL; AGES 21

- 64301 B WEST BOUNDARY,

WINNFIELD - 71483

(318)628-2151

1074764-001

WINNFIELD IGLESIAS JULIO PHY GENERAL PRACTICE 1 0 56 56 CURRENT PATIENTS

AGES 21 - 64301 A WEST BOUNDARY, SUITE

A, WINNFIELD - 71483

(318)628-2108

1317519-001

WINNFIELD NAGALLA BABY PHY GENERAL PRACTICE K 1 0 600 2500 AGES 0 - 64427 WEST LAFAYETTE STREET,

WINNFIELD - 71483

(318)628-7374

1152609-001

Page 145 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



WINNFIELD SHALOM CLINIC FOR CHILDREN RHC RURAL HEALTH

CLINIC

K 2 0 1051 2500 AGES 0 - 20609 WEST COURT STREET,

SUITE B, WINNFIELD - 71483

(318)628-5518

1008524-001

ADELEYE, OLUSEGUN, MD - 1582018

OSHIKANLU, OLABISI, MD - 1996971

WINNFIELD WINN COMMUNITY HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 2 10 2000 AGES 0 - 64100 SOUTH MAGNOLIA STREET,

WINNFIELD - 71483

(318)648-0375

1885886-001

ACOSTA, BRYANT, PA - 1452602

DUCKWORTH, APRIL, NP - 1887781

SHELTON, MARK, MD - 1367800

Page 146 of 233



6REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

AVOYELLES

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

1

3

1

0

0

7

1

0

1

8

7

0

0

0

2

TOTAL 13 18 15 23,688 8,879 9,019

CATAHOULA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

1

0

0

1

2

0

1

1

1

2

0

0

0

1

TOTAL 4 6 5 8,000 2,085 2,128

Page 147 of 233



6REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

CONCORDIA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

0

4

0

0

1

1

0

2

0

5

0

0

0

0

1

TOTAL 7 8 3 11,612 4,260 4,350

GRANT

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

1

0

0

1

0

0

1

0

1

0

0

0

0

TOTAL 2 2 1 3,500 3,509 3,582

Page 148 of 233



6REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

LASALLE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

1

1

1

0

0

1

0

1

1

3

1

0

0

0

1

TOTAL 5 7 1 15,500 1,822 1,874

RAPIDES

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

9

2

7

2

1

1

2

0

20

2

32

4

5

0

0

2

TOTAL 24 65 14 58,997 23,484 23,965

Page 149 of 233



6REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

STATE OF MISSISSIPPI

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

0

0

0

0

0

0

0

3

0

0

0

0

0

0

0

TOTAL 2 3 0 7,500 0

VERNON

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

3

4

1

1

0

1

0

0

3

4

6

1

1

0

0

1

TOTAL 10 16 1 29,167 6,109 6,272

Page 150 of 233



6REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

WINN

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

2

0

1

1

1

2

1

0

2

0

0

0

1

TOTAL 5 6 2 7,156 2,829 2,915

Page 151 of 233



REGION 6

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 16

8

2

15

5

1

8

17

9

0

0

6

18

11

32

55

TOTAL 72 131 42 165,120 52,977 54,105

Page 152 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BIENVILLE

ARCADIA BIENVILLE FAMILY CLINIC - ARCADIA RHC RURAL HEALTH

CLINIC

K 1 2 735 3500 AGES 0 - 641175 PINE STREET, SUITE 100,

ARCADIA - 71001

(318)263-7970

1442950-001

EVANS, LOIS, NP - 1111350

GARDNER, TERRY, MD - 1494291

THOMAS, ASHLEY, NP - 1721379

ARCADIA WILLIS MEDICAL LLC PHY PEDIATRICS K 2 0 1989 2500 AGES 0 - 18600 FACTORY OUTLET DRIVE,

SUITE 12, ARCADIA - 71001

(318)263-4701

1352802-001

MCCULLOCH, CATRELL, MD - 1956252

WILLIS, MELINDA, MD - 1909921

RINGGOLD CHRISTUS COUSHATTA RINGGOLD

RURAL HEALTH CLINIC

RHC RURAL HEALTH

CLINIC

K 2 2 578 1000 AGES 0 - 643342 BIENVILLE HIGHWAY,

RINGGOLD - 71068

(318)894-9137

1444651-001

CHICO, GAVIN, MD - 1699799

GATES, PAMELA, NP - 1536989

WISE, WILLIAM, MD - 1722677

WOOD, ROBIN, NP - 1178063

BOSSIER

BOSSIER DAVID RAINES COMM HEALTH CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 1 2145 3000 AGES 0 - 641514 DOCTORS DRIVE, 3RD

FLOOR, BOSSIER - 71111

(318)549-2500

1706019-001

DANIELS, LARRY, MD - 1352896

HENDERSON, GEORGE, MD - 1190519

MILLER, MARY, NP - 1464597

BOSSIER CITY MANCHANDIA MANOHAR PHY PEDIATRICS K 1 0 2437 2500 AGES 0 - 13; BLOCKED

AGES 14 - 172706 SHED ROAD, BOSSIER CITY

- 71111

(318)747-5272

1314056-001

Page 153 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BOSSIER CITY QUYNH DANG MD AND WILLIS

KNIGHTON MEDICAL CENTER

PHY PEDIATRICS K 2 0 1179 1290 LIMITED PANEL;NEW PTS

AGES 0 - 2M; CURR PTS

3M-16Y

2300 HOSPITAL DRIVE, SUITE

120, BOSSIER CITY - 71111

(318)212-7883

1408166-001

DANG, QUYNH, MD - 1699128

MCLAREN, RHETT, MD - 1134333

PLAIN DEALING NCMC PLAIN DEALING MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 623 3000 ACCEPTING AGES 0 - 18

ONLY108 NORTH LOUISIANA STREET,

PLAIN DEALING - 71064

(318)326-7272

1444286-001

HAYNES, JR, JOHN, MD - 1083607

MCCOMMON, NICOLE, MD - 1092452

RICHARDSON, KATHLEEN, NP - 1533432

PLAIN DEALING PLAIN DEALING MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 1 1 381 3000 AGES 0 - 64110 FOREST STREET, PLAIN

DEALING - 71064

(318)326-4238

1441350-001

BAUDOIN, MINAO, MD - 1672998

SMITH, MARLA, PA - 1624853

CADDO

GILLIAM DAVID RAINES COMMUNITY HEALTH

CENTER - GILLIAM

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 1 516 1000 AGES 0 - 6412763 LAY STREET, GILLIAM -

71029

(318)296-4287

1946541-001

MILLER, ANGELA, NP - 1478491

SHREVEPORT CLAYTON TONYA PHY PEDIATRICS K 1 0 413 425 LIMITED

PANEL;CURRENT PTS &

FMLY MEMBERS AGES

0-64

6821 PINES ROAD, SUITE 200,

SHREVEPORT - 71129

(318)671-9309

1494046-001

SHREVEPORT CLIFTON VAUGHAN MD AND WILLIS


PHY PEDIATRICS K 1 1 50 50 LIMITED PANEL;

CURRENT PATIENTS

AGES 0 - 18

7847 YOUREE DRIVE,

SHREVEPORT - 71105

(318)212-3930

1356174-001

BURKE, SUZANNE, PA - 1356239

VAUGHN, CLIFTON, MD - 1313670

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SHREVEPORT DAVID RAINES COMMUNITY HEALTH

CENTER (site 001)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 1 2298 2500 AGES 0 - 641625 DAVID RAINES ROAD,

SHREVEPORT - 71107

(318)425-2252

1941638-001

COPELAND, KENT, MD - 1538841



SHREVEPORT DZURIK GERALD PHY PEDIATRICS K 1 0 268 268 CURRENT PATIENTS

AGES 0 - 181819 EAST 70TH STREET,

SHREVEPORT - 71105

(318)797-6601

1127281-001

SHREVEPORT FAKNER REGINA PHY PEDIATRICS K 1 0 2521 2500 MAX CAPACITY

EXCEEDED; AGES 0 - 181801 FAIRFIELD AVENUE, SUITE

203, SHREVEPORT - 71101

(318)226-4892

1667145-001

SHREVEPORT HARRIS LINDA PHY PEDIATRICS K 1 0 2225 2500 AGES 0 - 254571 NORTH MARKET,

SHREVEPORT - 71107

(318)222-4041

1312258-001

SHREVEPORT HATHORN ALFRED PHY PEDIATRICS K 1 0 3082 2500 MAX CAPACITY

EXCEEDED; AGES 0 - 202120 BERT KOUNS, SUITE L,

SHREVEPORT - 71118

(318)686-8197

1135127-001

SHREVEPORT HENSON STEPHANIE PHY PEDIATRICS K 1 0 1206 1206 CURRENT PATIENTS AND

NEWBORNS AGES 0 - 151801 FAIRFIELD AVENUE, SUITE


(318)848-2810

1493791-001

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SHREVEPORT HOLLIWAY BRONDWYN PHY PEDIATRICS K 1 0 2256 2500 AGES 0 - 203824 HEARNE AVENUE,

SHREVEPORT - 71103

(318)635-8606

1966207-001

SHREVEPORT IBRAHIM ABUBAKAR PHY FAMILY PRACTICE K 1 0 2311 2500 AGES 0 - 646821 PINES ROAD, SHREVEPORT

- 71129

(318)686-1522

1577766-001

SHREVEPORT JOBE A. F. PHY PEDIATRICS K 1 0 3131 2500 MAX CAPACITY

EXCEEDED; AGES 0 - 182521 BERT KOUNS,

SHREVEPORT - 71118

(318)687-4641

1075370-001

SHREVEPORT LOUD SUYAH PHY PEDIATRICS S 1 0 124 2500 AGES 0 - 154140 HOLLYWOOD AVENUE,

SUITE B-Z, SHREVEPORT - 71109

(318)946-8183

1612529-001

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SHREVEPORT LSU CHILDRENS CLINIC (site 001) PHY PEDIATRICS K 16 1 9565 12000 LIMITED PANEL; AGES 0 -

171602 KINGS HIGHWAY, #110,

SHREVEPORT - 71103

(318)675-8600

1444405-001

BARAJAZ, MICHELLE, MD - 1356841


BEAL, LAUREN, MD - 1059668

BIENVENU, STEVEN, MD - 1313521

CARPER, SHEYENNE, MD - 1214728

CEDOTAL, CHARLOTTE, MD - 1302414

COMEAU, JEAN - CLAUDE, MD - 1563161

COOPER, PAUL, MD - 1486621

FARRELL, SHEILA, MD - 1469041

GEORGE, ROSHAN, MD - 1072192

GILL, HOLLY, MD - 1936049

GILL, PRIMALJIT, MD - 1672068

GUASTELLA, TONI, NP - 1162167

HORTON, CHERRY, MD - 1053392

KAMPERT, AMANDA, MD - 1046345

SPRINGER, MARGARET ANN, MD - 1921483

WELLS, WANDA, MD - 1423092

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SHREVEPORT LSU FAMILY MEDICINE (site 003) PHY FAMILY PRACTICE K 17 4 2921 47000 AGES 0 - 641501 KINGS HIGHWAY,

SHREVEPORT - 71103

(318)675-5805

1444405-003

ATAWI, HOMAYOUN, MD - 1092312

BAUDOIN, TAMMY DAVIS, MD - 1386596

BEHBAHANI, SHOLEH, PA - 1591785

CARTER, KEVIN, MD - 1071366

EASTWOOD, ROBERT, PA - 1133361

EVERTON, VICTORIA, MD - 1584258

FORT, ASHLEY, PA - 1065676

FORT, JR., ARTHUR, MD - 1145793

GERMAN, JEFFREY, MD - 1666769

HARPER, MICHAEL, MD - 1311456

HEARD, FREDERICK, MD - 1995118

HOOD, JAN, MD - 1371394

ISHERWOOD, PHILLIP, MD - 1423131

KANAYAMA - TRIVEDI, STACY, MD - 1092479

MAYEAUX, EDWARD, MD - 1901156

NELSON, DAVID, MD - 1699179

POPE, JOHN, MD - 1918962

PORTER, NIKKI, PA - 1316458

RICHTER, RANDY, MD - 1371226

ROBERTS, RUSSELL, MD - 1199168

SARASWAT, NEVEDITA, MD - 1507059

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PROV.

TYPE



SHREVEPORT LSU INTERNAL MEDICINE CLINIC (site

002)

PHY INTERNAL MEDICINE 11 0 1223 20000 AGES 21 - 641501 KINGS HIGHWAY,

SHREVEPORT - 71103

(318)813-2562

1444405-002

BARFIELD, DEIRDRE, MD - 1919926


BEAL, LAUREN, MD - 1059668

BOLLINENI, DEEPTHI, MD - 1307971

DONG, CAIPING, MD - 1554588

JACKSON, ROBERT, MD - 1360694

KAHLON, GUNJAN, MD - 1023744

KHAN, SOHAIL, MD - 1092878

LU, JAMES, MD - 1324922

MANSI, ISHAK, MD - 1157252

STRAIN, DANIEL, MD - 1377660

SHREVEPORT MID CITY PEDIATRICS PHY PEDIATRICS S 7 0 276 276 CLOSED PANEL2225 LINE AVENUE,

SHREVEPORT - 71104

(318)221-2225

1794481-001

ATCHINSON, SHARYE, MD - 1571016

COCKRELL, JENNIFER, MD - 1072176

CUSH - JOHN, ANGELA, MD - 1494143

HAYNIE, ROBERT, MD - 1377741

HOBSON, EMILY, MD - 1463388

PACE, DAVID, MD - 1495212

RITCH, SCOTT, MD - 1987701

SHREVEPORT PARKER WILLIAM PHY PEDIATRICS K 1 0 691 691 CURRENT PATIENTS

AGES 0 - 187847 YOUREE DRIVE,

SHREVEPORT - 71105

(318)212-3930

1321079-001

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PROV.

TYPE



SHREVEPORT PEDIATRIC ASSOCIATES OF

SHREVEPORT, LLC


AGES 0 - 201717 EAST BERT KOUNS,

SHREVEPORT - 71105

(318)524-1717

1949205-001

BARNETT, DARRELL, MD - 1352713

BROWN, CHARLOTTE, MD - 1662895

HOLLADAY, LYNNE, MD - 1376396

KENDRICK, TERRY, MD - 1371793

SHREVEPORT ROUSSEAU JEAN PHY GENERAL SURGERY S 1 0 2189 2500 AGES 1 - 644140 HOLLYWOOD AVENUE,

SHREVEPORT - 71109

(318)621-9600

1334022-001

SHREVEPORT SATALURI SESHA PHY INTERNAL MEDICINE 1 0 612 2500 AGES 21 - 641801 FAIRFIELD AVENUE, SUITE


(318)848-2830

1099597-001

SHREVEPORT SENFF TOM PHY INTERNAL MEDICINE 1 0 716 2500 AGES 21 - 641534 ELIZABETH AVENUE,

SHREVEPORT - 71101

(318)673-8320

1199354-001

SHREVEPORT SHREVEPORT FAMILY MEDICINE &

KIDMED CLINIC


INTERNAL MEDICINE

K 1 1 2737 2500 MAX CAPACITY

EXCEEDED; AGES 0 - 647505 PINES ROAD, SUITE 1250,

SHREVEPORT - 71129

(318)686-3770

1946800-001

ANDERSON - DOZE, ELIZABETH, MD - 1530018

BARNES, JON, NP - 1131831

SHREVEPORT TOGUN KIKELOMO PHY PEDIATRICS K 1 0 2220 2500 AGES 0 - 40214 WEST 70TH STREET, SUITE


(318)869-2181

1535915-001

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SHREVEPORT WEBB ETHAN PHY INTERNAL MEDICINE 1 0 7 7 CLOSED PANEL1801 FAIRFIELD AVENUE, SUITE


(318)220-7047

1540030-001

SHREVEPORT WERNER CHARLES PHY INTERNAL MEDICINE 1 0 633 2500 AGES 21 - 641534 ELIZABETH AVENUE,

SHREVEPORT - 71101

(318)673-8320

1103829-001

SHREVEPORT WILLIAMS MELITA PHY FAMILY PRACTICE K 1 0 2084 2500 AGES 0 - 206821 PINES ROAD, SUITE 400,

SHREVEPORT - 71129

(318)686-7109

1706281-001

SHREVEPORT WINTERTON H. N. PHY PEDIATRICS K 1 0 277 277 CURRENT PATIENTS

AGES 0 - 181819 EAST 7OTH STREET,

SHREVEPORT - 71105

(318)797-6601

1912786-001

SHREVEPORT WK CENTER FOR PEDIATRICS - SOUTH PHY PEDIATRICS K 5 0 2115 2115 CURRENT PTS &

SIBLINGS, NEWBORNS

AGES 0 - 1MONTH

2518 BERT KOUNS,

SHREVEPORT - 71118

(318)212-5437

1025526-001

BURNS, KIMBERLY, MD - 1695815

CHHABRA, NEERA, MD - 1348074

LAWHON, MELISSA, MD - 1578479

MCCONNELL, NATALIE, MD - 1578568

RAO, SUDHA, MD - 1314617

SHREVEPORT YERRAPRAGGADA SREEDEVI PHY INTERNAL MEDICINE 1 0 616 2500 AGES 21 - 641534 ELIZABETH AVENUE,

SHREVEPORT - 71101

(318)673-8320

1690376-001

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PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



VIVIAN NORTH CADDO MEDICAL CENTER RHC RURAL HEALTH

CLINIC

K 4 2 2393 11000 AGES 0 - 641003 SOUTH SPRUCE STREET,

VIVIAN - 71082

(318)375-3239

1038130-001

BELLMAN, MARIA, MD - 1577901

HAYNES, JR, JOHN, MD - 1083607

LANDRENEAU, SEAN, NP - 1532916

LOCCO, VINCENT, MD - 1999814

MESSIER, JOHN, PA - 1626821

TAYLOR, STEPHEN, MD - 1356506

CLAIBORNE

HAYNESVILLE BUTLER - ABSHIRE RURAL HEALTH

CLINIC

RHC RURAL HEALTH

CLINIC

B 2 1 280 5500 AGES 0 - 64926 FRANCES DRIVE,

HAYNESVILLE - 71038

(318)624-0554

1944327-001

ABSHIRE, SAMUEL, MD - 1336491

BAGGETT, DEBRA, NP - 1433152

BUTLER, CLINT, MD - 1493929

HAYNESVILLE DAVID RAINES COMMUNITY HEALTH

CENTER (site 002)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 1 2 134 1000 AGES 0 - 641953 EAST MAIN STREET,

HAYNESVILLE - 71038

(318)624-1995

1941638-002

FARMER, BETTY, NP - 1349062


ST. PIERRE, MARY, NP - 1143723

HOMER CLAIBORNE FAMILY MEDICAL CLINIC PHY FAMILY PRACTICE K 4 0 757 7500 AGES 0 - 64912 WEST MAIN STREET, HOMER

- 71040

(318)927-3571

1113263-001

HAYNES, DONALD K, MD - 1048861

HAYNES, DONALD S, MD - 1486841

HAYNES, MARIA, MD - 1494534

HAYNES, WILLIAM, MD - 1347086

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PROV.

TYPE



HOMER FAMILY MEDICAL CLINIC OF HOMER PHY FAMILY PRACTICE K 1 2 957 3500 AGES 0 - 64104 MORRIS CIRCLE, HOMER -

71040

(318)927-6777

1443620-001

CARDIN, JOAN, NP - 1692247

RAY, AMELIA, NP - 1887838

SALMON, CLIFTON, MD - 1358827

HOMER WK CLAIBORNE REGIONAL HEALTH

CENTER

RHC RURAL HEALTH

CLINIC

K 1 1 447 3500 AGES 0 - 64104 MORRIS CIRCLE, HOMER -

71040

(318)927-1110

1442143-001

MCGOVERN, PATRICIA, NP - 1029050

SMITH, III, JOHN, MD - 1487384

DESOTO

LOGANSPORT DESOTO REGIONAL FAMILY MEDICINE -

LOGANSPORT

RHC RURAL HEALTH

CLINIC

K 1 1 632 2500 AGES 0 - 64110 MAIN STREET, LOGANSPORT

- 71049

(318)697-2273

1445932-001

KAMBEROV, DENIS, MD - 1530069

RICHARDSON, MELISSA, NP - 1553611

MANSFIELD COMMUNITY HEALTH INSTITUTE RHC RURAL HEALTH

CLINIC

K 2 1 245 1000 AGES 0 - 64907 POLK STREET, MANSFIELD -

71052

(318)872-1015

1310018-001

COMBS, JR, S BEWELL, MD - 1111775

HATHORN, JR, ALFRED, MD - 1135127

MORRIS, DETRIES, NP - 1556548

MANSFIELD DESOTO REGIONAL FAMILY MEDICINE PHY GENERAL PRACTICE K 5 1 2148 13000 AGES 0 - 64130 JEFFERSON STREET,

MANSFIELD - 71052

(318)872-2700

1948357-001

DILLARD, LEIGH, MD - 1145751

EUBANKS, LORI, NP - 1179892

EVANS, JEFFERY, MD - 1325961

KAMBEROV, DENIS, MD - 1530069

LEGGIO, BENJAMIN, MD - 1384071

TAYLOR, DONALD, MD - 1090751

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PROV.

TYPE



NATCHITOCHES

NATCHITOCHES BLACK JORGE PHY PEDIATRICS K 1 0 967 2500 AGES 0 - 20617 BIENVILLE STREET,

NATCHITOCHES - 71457

(318)238-5040

1099309-001

NATCHITOCHES BREAZEALE ARCHIE PHY GENERAL PRACTICE 1 0 60 60 CURRENT PATIENTS

AGES 21 - 64108 TOULINE, NATCHITOCHES -

71457

(318)352-3804

1003930-001

NATCHITOCHES CORNERSTONE PEDIATRICS PHY PEDIATRICS K 3 0 2674 2674 CURRENT PATIENTS

AGES 0 - 171055 PARKWAY DRIVE, SUITE A,


(318)352-6464

1441139-001

RODRIGUEZ, BRETT, MD - 1495476

RODRIGUEZ, CHRISTA, MD - 1345253

THIBODAUX, JR., JAMES, MD - 1487465

NATCHITOCHES HOGG JOHN PHY FAMILY PRACTICE K 1 0 275 275 OPEN AGES 0 - 3

MONTHS; CURRENT PTS

AGES 4M - 20YR

740 KEYSER AVENUE, SUITE C,


(318)352-6800

1555037-001

NATCHITOCHES OUTPATIENT MEDICAL CENTER, INC. @

NATCHITOCHES

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 0 1274 5000 AGES 0 - 641640 BREAZEALE SPRINGS

STREET, NATCHITOCHES - 71457

(318)352-9299

1941018-001

MATTA, ANIL, MD - 1071200

ROBERTS, LYNDA, MD - 1387461

NATCHITOCHES SHALOM CLINIC FOR CHILDREN PHY PEDIATRICS K 2 0 2107 5000 OPEN AGES 0 - 1MNTH;

BLOCKED 2MONTHS -

18YRS

405 BIENVILLE STREET,


(318)356-7211

1949574-001

ADELEYE, OLUSEGUN, MD - 1582018

OSHIKANLU, OLABISI, MD - 1996971

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PROV.

TYPE



RED RIVER

COUSHATTA CHRISTUS COUSHATTA RURAL

HEALTH CENTER

RHC RURAL HEALTH

CLINIC

K 1 2 368 3000 AGES 0 - 641633 MARVEL STREET,

COUSHATTA - 71019

(318)932-2222

1443913-001

CHICO, GAVIN, MD - 1699799

GATES, PAMELA, NP - 1536989

WOOD, ROBIN, NP - 1178063

COUSHATTA D GREGORY BELL, MD & WILLIS


PHY PEDIATRICS /

INTERNAL MEDICINE

B 1 1 707 3000 AGES 0 - 641633 MARVEL STREET,

COUSHATTA - 71019

(318)932-2170

1032051-001

BELL, DON G, MD - 1140350

GERLACH, SHELLY, NP - 1032093

COUSHATTA HOLLOWAY ESTHER PHY FAMILY PRACTICE K 1 0 257 2500 AGES 0 - 641633 MARVEL STREET,

COUSHATTA - 71019

(318)932-8937

1059072-001

COUSHATTA WYCHE T. COLEMAN JR. LIMITED PHY FAMILY PRACTICE B 1 1 1248 3000 AGES 0 - 641633 MARVEL STREET,

COUSHATTA - 71019

(318)932-9980

1447994-001

COLEMAN, WYCHE, MD - 1303003

WILSON, LAVORA, NP - 1621293

SABINE

MANY HUSAM SUKEREK MD RHC RURAL HEALTH

CLINIC

K 1 0 1439 2500 AGES 0 - 20210 HIGHLAND DRIVE, MANY -

71449

(318)256-5722

1034177-001

SUKEREK, HUSAM, MD - 1436542

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PROV.

TYPE



MANY SABINE MEDICAL CENTER RURAL

HEALTH CLINIC #1

RHC RURAL HEALTH

CLINIC

K 3 1 1009 8000 AGES 0 - 64395 SOUTH CAPITAL, MANY -

71449

(318)256-2000

1021971-001

FOUNDS, GREGORY, MD - 1158135

FOUNDS, WARREN, MD - 1050113

PEARSON, CHARLES, MD - 1158364

VINES, MELISSA, NP - 1021377

ZWOLLE SABINE MEDICAL CENTER RURAL

HEALTH CLINIC #2

RHC RURAL HEALTH

CLINIC

K 1 0 137 2500 AGES 0 - 641015 OBRIE STREET, ZWOLLE -

71486

(318)645-6161

1037605-001

LAU, CHI - TAI, MD - 1494909

ZWOLLE ZWOLLE RURAL CLINIC RHC RURAL HEALTH

CLINIC

K 1 1 591 1000 AGES 0 - 642026 OBRIE STREET, ZWOLLE -

71486

(318)645-6013

1447242-001

GARCIE, AMY, NP - 1149811

LEGGIO, BENJAMIN, MD - 1384071

WEBSTER

MINDEN BLAKE - MCMAHON ANDREA PHY INTERNAL MEDICINE /

PEDIATRICS

K 1 0 755 2500 AGES 0 - 64129 MINDEN SHOPPING CENTER

DRIVE, MINDEN - 71055

(318)377-2007

1150185-001

MINDEN BOLGER JOSEPH PHY FAMILY PRACTICE S 1 0 75 200 LIMITED PANEL; AGES 0 -

20#3 MEDICAL PLAZA, MINDEN -

71055

(318)377-7118

1052825-001

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PROV.

TYPE



MINDEN DAVID RAINES COMMUNITY HEALTH

CENTER (site 003)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 0 3 461 1000 AGES 0 - 64128 HOMER ROAD, MINDEN -

71055

(318)377-1545

1941638-003

FARMER, BETTY, NP - 1349062


ST. PIERRE, MARY, NP - 1143723

MINDEN FAMILY MEDICINE ASSOCIATES OF

MINDEN

RHC RURAL HEALTH

CLINIC

K 1 2 712 2000 AGES 0 - 641111 HOMER ROAD, MINDEN -

71055

(318)377-7500

1043630-001

BROWN, ROBERT, NP - 1128244

SMITH, III, JOHN HENRY, MD - 1487384

WILLIS, REGINA, NP - 1457388

MINDEN IRIZARRY CARLOS PHY FAMILY PRACTICE K 1 0 589 2500 AGES 0 - 64#2 MEDICAL PLAZA, MINDEN -

71055

(318)377-8400

1928275-001

MINDEN MINDEN FAMILY CARE CENTER RHC RURAL HEALTH

CLINIC

K 2 3 997 6500 AGES 0 - 64208 MORRIS DRIVE, MINDEN -

71055

(318)377-8260

1944645-001

COOK, JOANN, NP - 1685461

DEVILLE, KATHLEEN, NP - 1325686

FLEMING, JOHN, MD - 1320269

PISTORIUS, MICHAEL, MD - 1337846

SCHUT, STEPHANIE, NP - 1034975

MINDEN MINDEN FAMILY MEDICINE PHY FAMILY PRACTICE S 2 0 178 200 LIMITED PANEL; AGES 0 -

20#3 MEDICAL PLAZA, MINDEN -

71055

(318)377-7134

1441678-001

CHANLER, MICHAEL, MD - 1571181

EARNHARDT, CHRISTOPHER, MD - 1571261

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NO.

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PHYS.

*

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SPECIALTY

PROV.

TYPE



MINDEN MINDEN PEDIATRICS LLC PHY PEDIATRICS K 1 1 1615 3000 AGES 0 - 20607 FLEMING LANE, MINDEN -

71055

(318)377-7116

1325074-001

BRASHER, LESLIE, NP - 1325295

ULICH, MICHAEL, MD - 1583740

MINDEN STELL FAMILY PRACTICE PHY FAMILY PRACTICE K 1 1 581 3000 AGES 0 - 64102 OFFICE PARK BOULEVARD,

MINDEN - 71055

(318)377-2885

1448079-001

STELL, GERALD, MD - 1925799

STELL, MARY, NP - 1721051

SAREPTA NORTH WEBSTER MEDICAL CLINIC PHY FAMILY PRACTICE /

GENERAL PRACTICE

S 1 0 397 2500 AGES 0 - 64106 TRI - STATE DRIVE, SAREPTA

- 71071

(318)994-2266

1452629-001

NIDA, JOSEPH, MD - 1053881

SIBLEY PHILLIPS GREGORY PHY FAMILY PRACTICE K 1 0 423 2500 AGES 0 - 64; ACCEPTS

NEW PTS AGES 0 - 17

ONLY


SIBLEY - 71073

(318)382-9401

1495344-001

SPRINGHILL SMC / DOCTORS CLINIC RHC RURAL HEALTH

CLINIC

K 6 2 1154 13500 AGES 0 - 64401 ELEVENTH STREET

NORTHEAST, SPRINGHILL - 71075

(318)539-1700

1448290-001

CASSIDY, TOMMIE, NP - 1309290

HOLLADAY, JR, SAMUEL, MD - 1026760

LAW, DAVID, MD - 1156361

PARDUE, MICHELLE, MD - 1071404

SESSIONS, JERRY, MD - 1156353

SMITH, MARLA, PA - 1624853

TORRENCE, JR, LEAMON, MD - 1349402

TORRES - CABRERA, FELIX, MD - 1996904

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7REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

BIENVILLE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

0

0

0

0

0

2

0

2

1

1

0

0

0

0

1

TOTAL 3 5 4 7,000 2,798 2,864

BOSSIER

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

0

0

0

0

1

2

0

3

0

5

0

0

0

0

0

TOTAL 5 8 3 12,790 13,404 13,736

Page 169 of 233



7REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

CADDO

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

17

6

4

0

0

2

1

1

43

12

23

3

3

0

0

4

TOTAL 31 88 11 137,353 45,432 46,440

CLAIBORNE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

2

0

0

1

2

0

1

1

6

1

0

0

0

0

TOTAL 5 9 6 21,000 2,683 2,766

Page 170 of 233



7REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

DESOTO

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

1

0

0

2

0

1

3

1

3

0

0

0

0

TOTAL 3 8 3 16,500 4,227 4,331

NATCHITOCHES

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

3

0

1

1

0

1

0

0

6

0

3

1

0

0

0

0

TOTAL 6 10 0 15,509 6,967 7,131

Page 171 of 233



7REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

RED RIVER

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

0

2

0

0

0

1

0

0

1

3

0

0

0

0

0

TOTAL 4 4 4 11,500 1,765 1,796

SABINE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

0

0

0

4

0

0

1

4

0

0

0

0

1

TOTAL 4 6 2 14,000 3,585 3,673

Page 172 of 233



7REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

WEBSTER

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

1

6

0

0

1

3

0

1

3

10

3

0

0

0

1

TOTAL 12 18 12 39,400 7,102 7,290

Page 173 of 233



REGION 7

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 25

7

1

17

6

0

2

15

7

0

0

3

11

22

57

56

TOTAL 73 156 45 275,052 87,963 90,027

Page 174 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



CALDWELL

COLUMBIA CITIZENS RURAL CLINIC RHC RURAL HEALTH

CLINIC

K 3 3 1173 9000 AGES 0 - 64484 COLLINS ROAD, SUITE A,

COLUMBIA - 71418

(318)649-5300

1443930-001

CONNELL, III, ROBERT, MD - 1179256

CUMMINGS, LAURA, NP - 1147923

CUMMINGS, JR, RUSSELL, MD - 1312053

ELLERBE, WILLIAM, MD - 1092169

HAWKINS, KIMBERLY, NP - 1363910

MAY - LILLO, LEA, NP - 1582093

COLUMBIA SHROFF PANKAJRAI PHY INTERNAL MEDICINE 1 0 16 16 CURRENT PATIENTS

AGES 21 - 647937 US HIGHWAY 165,

COLUMBIA - 71418

(318)649-2621

1319350-001

COLUMBIA WINTERS CLINIC RHC RURAL HEALTH

CLINIC

K 2 3 720 3500 AGES 0 - 64421 MAIN STREET, COLUMBIA -

71418

(318)649-6157

1943991-001

CARROLL, JR, ELDREDGE, MD - 1110388

HERNANDEZ, CARLOS, PA - 1625892

HOLMAN, MICKEL, PA - 1407941

OPERARIO, MARK, MD - 1661881

WEST, JANICE, NP - 1456772

EAST CARROLL

LAKE

PROVIDENCE

FAMILY MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

S 1 1 488 3000 AGES 0 - 64300 SCARBOROUGH, LAKE

PROVIDENCE - 71254

(318)559-2814

1448061-001

BAILEY, DON, MD - 1171425

HALE, AMY, NP - 1314315

Page 175 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LAKE

PROVIDENCE

FAMILY PRACTICE CLINIC, THE RHC RURAL HEALTH

CLINIC

K 2 1 1609 5500 AGES 0 - 64320 NORTH HOOD STREET, LAKE

PROVIDENCE - 71254

(318)559-2404

1947873-001

MILLER, BRENDA, NP - 1437565

PERKINS, CAMILLE, MD - 1926639

SIMON, LLEWELLYN, MD - 1680893

LAKE

PROVIDENCE

LAKE PROVIDENCE MEDICAL CENTER RHC RURAL HEALTH

CLINIC

K 2 1 653 5500 AGES 0 - 64319 NORTH HOOD STREET, LAKE

PROVIDENCE - 71254

(318)559-1221

1944521-001

FAKHRE, GEORGE, MD - 1534641

KATAKAM, SHESHA, MD - 1173002

TYLER, TIMOTHY, PA - 1625086

FRANKLIN

WINNSBORO COLVIN MEDICAL CORP PHY FAMILY PRACTICE K 1 3 1090 3000 AGES 0 - 642106 - A LOOP ROAD,

WINNSBORO - 71295

(318)435-8020

1449571-001

COLVIN, THOMAS, MD - 1387533

DYKES, RYAN, NP - 1407241

LOCKARD, JOYCE, NP - 1332062

SANFORD, JORIE, NP - 1140686

WINNSBORO COUGHRAN MEDICAL CORPORATION PHY FAMILY PRACTICE K 1 4 1068 3500 AGES 0 - 642106 - A LOOP ROAD,

WINNSBORO - 71295

(318)435-8020

1449130-001

COUGHRAN, JIMMY, MD - 1971391

DYKES, RYAN, NP - 1407241

LOCKARD, JOYCE, NP - 1332062

PHILLIPS, ELIZABETH, NP - 1014231

SANFORD, JORIE, NP - 1140686

Page 176 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



WINNSBORO FRANKLIN MEDICAL CENTER RHC RHC RURAL HEALTH

CLINIC

K 2 8 753 5500 AGES 0 - 642104 LOOP ROAD, SUITE C,

WINNSBORO - 71295

(318)435-4571

1449954-001

CARSON, PAIGE, NP - 1453242

ELDRIDGE, JOEL, DO - 1918296

FLORICE, JOE, NP - 1454346

HOWARD, SUSAN, NP - 1434922

MOBERLEY, COURTNEY, NP - 1722227

MORGAN, BELINDA, NP - 1544060

ROBERSON, STEVE, NP - 1025488

WEGNER, MATTHEW, NP - 1787132

WHITE, II, GORDON, MD - 1423688

YELVERTON, EMILIANA, NP - 1623466

WINNSBORO WINNSBORO MEDICAL CLINIC PHY FAMILY PRACTICE K 1 3 1099 3500 AGES 0 - 643326 FRONT STREET, SUITE B,

WINNSBORO - 71295

(318)435-7333

1940445-001

ALLEN, LINDA, NP - 1564893

COBB, TANYA, NP - 1509604

HENSLEY, RHONDA, NP - 1548162

REED, CHARLES, MD - 1357898

WISNER WISNER MEDICAL CLINIC FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 3 294 3000 AGES 0 - 64126 WATSON STREET, WISNER -

71378

(318)724-7008

1946036-001


GRAY, CYNTHIA, NP - 1378127

PORTER, MARY, NP - 1469785

SMITH, ROGER, MD - 1386839


Page 177 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



WISNER WISNER RURAL HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 2 2 313 1000 AGES 0 - 64176 WATSON, WISNER - 71378

(318)724-6789

1408743-001

CARROLL, JR, ELDREDGE, MD - 1110388

HERNANDEZ, CARLOS, PA - 1625892

HOLMAN, MICKEL, PA - 1407941

OPERARIO, MARK, MD - 1661881

JACKSON

JONESBORO AGARWAL KUSHAL PHY INTERNAL MEDICINE K 1 0 369 2500 AGES 7 MONTHS - 64

YEARS510 ALEXANDER STREET,

JONESBORO - 71251

(318)259-2148

1968846-001

JONESBORO CROUCH REBECCA PHY GENERAL SURGERY S 1 0 305 2500 AGES 1 - 64166 BEECH SPRINGS,

JONESBORO - 71251

(318)259-3668

1934917-001

JONESBORO JACKSON PARISH HOSPITAL FAMILY

CARE CLINIC (site 001)

RHC RURAL HEALTH

CLINIC

K 1 1 1170 3000 AGES 0 - 64107 WATTS STREET,

JONESBORO - 71251

(318)395-2121

1447935-001

BOUTROS, NIDAL, MD - 1457442

CUMMINGS, LORI, NP - 1141038

JONESBORO JONESBORO FAMILY CARE CLINIC RHC RURAL HEALTH

CLINIC

S 1 1 474 3000 AGES 6 - 64187 BEECH SPRINGS ROAD,

JONESBORO - 71251

(318)395-0521

1448231-001

HATTAWAY, LIZABETH, NP - 1333603

JACOB, ABRAHAM, MD - 1053538

LINCOLN

Page 178 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



RUSTON AGARWAL KUSHAL PHY INTERNAL MEDICINE K 1 0 244 2500 AGES 7 MONTHS - 64

YEARS411 EAST VAUGHN AVENUE,

SUITE 102, RUSTON - 71270

(318)259-2148

1968846-002

RUSTON BELUE JAMES PHY FAMILY PRACTICE K 1 0 1541 2500 AGES 0 - 64411 EAST VAUGHN, SUITE 105,

RUSTON - 71270

(318)251-3774

1335835-001

RUSTON CONVILLE STACY PHY FAMILY PRACTICE S 1 0 14 2500 AGES 0 - 64411 EAST VAUGHN AVENUE,

SUITE 200, RUSTON - 71270

(318)251-8232

1052931-001

RUSTON FAMILY FIRST MEDICINE APMC RHC RURAL HEALTH

CLINIC

K 1 1 1022 3000 AGES 0 - 641503 GOODWIN ROAD, SUITE

207, RUSTON - 71270

(318)513-1950

1448541-001

CARTER, SANDRA, NP - 1141721

SMITH, JERRY, MD - 1691542

RUSTON FIGUEROA GLENN PHY INTERNAL MEDICINE 1 0 72 2500 AGES 21 - 64411 EAST VAUGHN, SUITE 101,

RUSTON - 71270

(318)255-4076

1664197-001

RUSTON GREEN CLINIC, LLC (site 001) PHY PEDIATRICS K 4 0 1590 1590 CURRENT PATIENTS

AGES 0 - 181200 SOUTH FARMERVILLE

STREET, RUSTON - 71270

(318)255-3690

1006858-001

DAHER, MARLENE, MD - 1967122

MCGEHEE, DAVID, MD - 1337056

MOAK, CANDACE, MD - 1130796

SLUSHER, TONYA, MD - 1495662

Page 179 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



RUSTON GREEN CLINIC, LLC (site 002) PHY INTERNAL MEDICINE 2 0 14 14 CLOSED PANEL1200 SOUTH FARMERVILLE


(318)255-3690

1006858-002

MARIANO, EDWARD, MD - 1110469

MARIANO, SHEILA, MD - 1431231

RUSTON GREEN CLINIC, LLC (site 003) PHY FAMILY PRACTICE K 2 0 357 357 LIMITED PANEL; AGES 0 -

18; CLOSED AGES 19 - 64206 REYNOLDS DRIVE, SUITE K,

RUSTON - 71270

(318)255-1515

1006858-003

PHILLIPS, SHANE, MD - 1164097

WOOD, JACOB, MD - 1328201

RUSTON GREEN CLINIC, LLC (site 004) PHY INTERNAL MEDICINE 1 0 19 20 LIMITED PANEL; AGES 21

- 641200 SOUTH FARMERVILLE


(318)255-3690

1006858-004

TAMAKLOE, MARTINA, MD - 1331767

RUSTON GREEN CLINIC, LLC (site 005) PHY INTERNAL MEDICINE 1 0 20 20 LIMITED PANEL; AGES 21

- 641200 SOUTH FARMERVILLE


(318)255-3690

1006858-005

TAMAKLOE, SEDO, MD - 1036790

RUSTON HERBERT ALLEN PHY GENERAL PRACTICE K 1 0 326 326 CURRENT PATIENTS

AGES 0 - 64411 EAST VAUGHN, SUITE 203,

RUSTON - 71270

(318)255-7474

1126403-001

RUSTON MCINTYRE BRENDA PHY PEDIATRICS K 1 0 478 2500 AGES 0 - 201003 WHITE STREET, RUSTON -

71270

(318)255-4112

1343072-001

MADISON

Page 180 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



TALLULAH BROWN EVERETT PHY PEDIATRICS K 1 0 298 2500 AGES 0 - 6410 CROTHERS DRIVE, SUITE 4,

TALLULAH - 71282

(318)574-2764

1042935-001

TALLULAH CHENIER LAWRENCE PHY GENERAL PRACTICE S 1 0 643 2500 AGES 0 - 641000 JOHNSON STREET,

TALLULAH - 71282

(318)574-5974

1316288-001

TALLULAH OUTPATIENT MEDICAL CENTER, INC. @

TALLULAH

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 0 1062 5000 AGES 0 - 64804 BEECH STREET, TALLULAH -

71282

(318)574-1453

1941042-001

PERRY, DONALD, MD - 1330159

WYCHE, RONALD, MD - 1173045

TALLULAH THOMAS A. NEUMANN, MD, APMC RHC RURAL HEALTH

CLINIC

K 1 1 1217 3000 AGES 0 - 64212 SOUTH CHESTNUT STREET,

TALLULAH - 71282

(318)574-3575

1446513-001

COLLINS, STEPHANIE, NP - 1165221

NEUMANN, THOMAS, MD - 1105015

MOREHOUSE

BASTROP COATS JOHN PHY FAMILY PRACTICE K 1 0 190 900 LIMITED PANEL; AGES 6 -

64327 WEST HICKORY AVENUE,

BASTROP - 71220

(318)556-3071

1381705-001

BASTROP FAMILY MEDICAL CENTER PHY INTERNAL MEDICINE /

NEUROLOGY

S 1 0 377 2500 AGES 0 - 64540 DURHAM STREET, BASTROP

- 71220

(318)283-2200

1447111-002

QAYYUM, TAHIR, MD - 1680061

Page 181 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BASTROP MOREHOUSE COMMUNITY MEDICAL

CENTERS, INC.

FQHC PEDIATRICS K 2 5 1327 3500 AGES 0 - 64518 DURHAM STREET, BASTROP

- 71220

(318)283-8887

1019798-001

GALLIEN, SUSAN, NP - 1169323

GREEN, DEBORAH, NP - 1436348

HAWTHORNE, T DOLORES, NP - 1629219

MALIK, SHAHZAD, MD - 1147222

MANSFIELD, CHELSEA, NP - 1030040

TREJO, DANIEL, MD - 1153281

WADE, LALISA, NP - 1032671

BASTROP NOBLE JACK PHY FAMILY PRACTICE 1 0 18 18 CURRENT PATIENTS

AGES 21 - 64355 WEST HICKORY, BASTROP -

71220

(318)281-4450

1199346-001

BASTROP TRAN ANDY PHY FAMILY PRACTICE K 1 0 1199 2500 AGES 0 - 64365 WEST HICKORY, BASTROP -

71220

(318)283-5999

1495794-001

BASTROP TREJO DANIEL PHY FAMILY PRACTICE K 1 0 964 964 CURRENT PATIENTS AND

NEWBORNS AGES 0 - 64511 GUNBY AVENUE, BASTROP -

71220

(318)281-2410

1153281-001

MER ROUGE ALLEN L. SPIRES, MD, APMC PHY INTERNAL MEDICINE K 1 1 1716 3000 AGES 0 - 64301 DAVENPORT AVENUE, MER

ROUGE - 71261

(318)647-5008

1446629-001

HAYDEN, ERIN, NP - 1478351

SPIRES, ALLEN, MD - 1357774

Page 182 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MER ROUGE FAMILY MEDICAL CLINIC OF MER

ROUGE

PHY FAMILY PRACTICE K 1 1 1215 3000 AGES 0 - 64205 SOUTH DAVENPORT

AVENUE, MER ROUGE - 71261

(318)647-3720

1949434-001

HEATH, LANA, NP - 1029556

WEBB, GEORGE, MD - 1339822

OUACHITA

MONROE ACHILIHU GODFREY PHY CARDIOVASCULAR

DISEASE

1 0 126 2500 AGES 21 - 64614 NORTH 2ND STREET,

MONROE - 71210

(318)330-9330

1681903-001

MONROE BATTLES CAROLINE PHY FAMILY PRACTICE S 1 0 20 20 CURRENT PATIENTS

AGES 0 - 642221 JUSTICE STREET, MONROE

- 71201

(318)329-3395

1386359-002

MONROE BROWN - MANNING CYNTHIA PHY FAMILY PRACTICE S 1 0 226 226 CURRENT PATIENTS

AGES 0 - 641825 NORTH 18TH STREET,

SUITE B, MONROE - 71201

(318)324-0818

1493848-001

MONROE FAMILY MEDICAL CENTER PHY FAMILY PRACTICE K 1 0 1523 2500 AGES 0 - 643418 MEDICAL PARK DRIVE,

SUITE 32, MONROE - 71203

(318)325-3332

1447111-001

QAYYUM, MUHAMMAD, MD - 1680061

MONROE INTERNAL MEDICINE OF THE TWIN

CITIES

PHY INTERNAL MEDICINE 2 0 152 152 CURRENT PATIENTS

AGES 21 - 643510 MEDICAL PARK DRIVE,

SUITE 9, MONROE - 71203

(318)388-6050

1446653-001

EL - MALAH, AMIN, MD - 1437719

SHAFIEI, KHALED, MD - 1423521

Page 183 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MONROE KIDHEALTH, LLC PHY PEDIATRICS / FAMILY

PRACTICE

K 1 1 177 2500 AGES 0 - 205000 FORSYTHE BYPASS, SUITE

2, MONROE - 71201

(318)812-0168

1923141-001

SAADAT, LYNDALL, MD - 1930695

SATERFIEL, DONNA, NP - 1539899

MONROE LAPITE OLADAPO PHY FAMILY PRACTICE S 1 0 1107 2500 AGES 0 - 35306 STONE AVENUE, MONROE -

71202

(318)323-1040

1665479-001

MONROE LSU - MONROE \ EA CONWAY - ADULT

CLINIC (site 003)

PHY INTERNAL MEDICINE S 8 4 570 9500 AGES 13 - 644864 JACKSON STREET,

MONROE - 71202

(318)330-7167

1947288-003

BREWER, JONATHAN, PA - 1781371

CAVELL, RICHARD, MD - 1313858

CHAO, DEADRE, MD - 1690791

GIVLER, DONALD, MD - 1351326

JONES, TAMMY, MD - 1986208

KINTZING, WILIAM, MD - 1344010

MISTRY, F.D., MD - 1541958

MOORE, KATHY, NP - 1541834

MORRIS, LACEY, NP - 1584941

PARKER, ROBERT, MD - 1987433

RUTHERFORD, W. E., MD - 1184390

SOLLEY, SUSAN, NP - 1142557

MONROE LSU - MONROE \ EA CONWAY - FAMILY

PRACTICE (site 001)

PHY FAMILY PRACTICE K 5 0 1520 10000 AGES 0 - 644864 JACKSON STREET,

MONROE - 71202

(318)330-7600

1947288-001

CHAO, DEARDRE, MD - 1690791

GIVLER, JR., DONALD, MD - 1351326

KINTZING, WILLIAM, MD - 1344010

LUTHER, EUIL, MD - 1396729

PARKER, ROBERT, MD - 1987433

Page 184 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MONROE LSU - MONROE \ EA CONWAY -

PEDIATRICS (site 002)

PHY PEDIATRICS K 2 0 1204 5000 AGES 0 - 124864 JACKSON STREET,

MONROE - 71202

(318)330-7169

1947288-002

PATEL, ARVIND, MD - 1175234

SMITH, DENIS, MD - 1162396

MONROE NORTHEAST RURAL HEALTH CENTER PHY PEDIATRICS K 1 1 2206 2500 AGES 0 - 642101 TOWER DRIVE, MONROE -

71201

(318)387-4878

1947695-001

MAYS, GLORIA, NP - 1706591

MICKAIL, MAMDOUH, MD - 1358959

MONROE PATTERSON JAMES PHY FAMILY PRACTICE S 1 0 739 2500 AGES 0 - 641511 ORANGE STREET, MONROE

- 71202

(318)322-7798

1330094-001

MONROE PEDIATRICS PLUS AMC PHY PEDIATRICS S 2 1 290 290 CURRENT PATIENTS AND

SIBLINGS AGES 0 - 153401 MAGNOLIA COVE, MONROE

- 71203

(318)325-6311

1941476-001

CARR, VIVIAN, NP - 1434931

DYESS, BONITA, MD - 1304875

ZUKOWSKI, NANCY, MD - 1432946

MONROE PRIMARY HEALTH SERVICES CENTER FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 3 6 2150 4500 AGES 0 - 642913 DESIARD STREET, MONROE

- 71202

(318)651-9914

1441431-001

CAIRE, MICHAEL, MD - 1539121


CLARK, REBECCA, NP - 1362484

CROCKETT, ALECIA, NP - 1143235

DAVIS, MARYANNE, MD - 1439916


POLIQUIT, RAYMOND, MD - 1989215

POPE, SHELIA, NP - 1529265

WASHINGTON, ADRIAN, NP - 1024368

Page 185 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MONROE PRIMARY HEALTH SERVICES CENTER

(site 002)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

S 2 7 688 3000 AGES 0 - 641805 JACKSON STREET,

MONROE - 71202

(318)651-0041

1949086-002

CAIRE, MICHAEL, MD - 1539121


CLARK, REBECCA, NP - 1362484

CROCKETT, ALECIA, NP - 1143235

DAVIS, MARYANNE, NP - 1439916


POLIQUIT, RAYMOND, MD - 1989215

POPE, SHELIA, NP - 1529265

WASHINGTON, ADRIAN, NP - 1024368

MONROE PROGRESSIVE PEDIATRICS PHY PEDIATRICS S 2 0 208 240 LIMITED PANEL;


20

3116 KILPATRICK BOULEVARD,

MONROE - 71201

(318)410-9898

1456918-001

KHANFAR, NASHAT, MD - 1559067

YUSUF, MUNIRA, MD - 1042056

MONROE RANDY W. HEAD MD APMC PHY FAMILY PRACTICE K 2 0 4479 5000 AGES 0 - 641470 GARRETT ROAD, MONROE -

71203

(318)387-3888

1444987-001

BURNS, GEORGIANNA, MD - 1671631

HEAD, RANDY, MD - 1663280

MONROE SOLE CARE, LLC PHY GENERAL PRACTICE /

FAMILY PRACTICE

K 1 1 283 3000 AGES 0 - 642803 EVANGELINE STREET,

MONROE - 71201

(318)325-0325

1349429-001

STEWART - DIXON, TAMMY, NP - 1141283

TUCKER, TYRONE, MD - 1434531

Page 186 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MONROE ST. FRANCIS CONVENIENCE CLINIC PHY FAMILY PRACTICE S 1 8 3067 4500 AGES 0 - 64920 OLIVER ROAD, SUITE 1600,

MONROE - 71201

(318)327-6220

1446076-001

BLANSON, DEBORAH, NP - 1561461

CULP, DAVID, NP - 1434132

DROST, KELLI, NP - 1181790

DROST, KELLI, NP - 1181790

ISLAM, NAHID, MD - 1547298

MANSFIELD, CHELSEA, NP - 1030040

SMITH, NAOMI, NP - 1477371

STEWART - DIXON, TAMMY, NP - 1142183

WILLIAMS, LATONYA, NP - 1013628

MONROE ST. FRANCIS HEALTHY KIDS CLINIC PHY PEDIATRICS K 3 3 2110 9000 AGES 0 - 20920 OLIVER ROAD, SUITE 800,

MONROE - 71201

(318)966-6165

1098906-001

MALMAY, KIM, MD - 1352420

MCDOUGAL, DEANNA, NP - 1149250

OBOYLE, MEADE, MD - 1306860


ROSALES, JR., JOAQUIN, MD - 1348597

ST. PIERRE, ROBIN, NP - 1793876

MONROE WALTERS, JR. KERMIT PHY FAMILY PRACTICE S 1 0 1695 2500 AGES 0 - 641910 JACKSON STREET,

MONROE - 71202

(318)325-7998

1313220-001

MONROE WILLIAMS THOMAS PHY PEDIATRICS S 1 0 24 24 CLOSED PANEL516 LINCOLN ROAD, MONROE -

71203

(318)343-6487

1685895-001

Page 187 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



STERLINGTON STERLINGTON CLINIC RHC RURAL HEALTH

CLINIC

S 2 1 615 3000 AGES 0 - 64115 HIGHWAY 2, STERLINGTON -

71280

(318)665-4543

1014605-001

FLETCHER, KIM, NP - 1014923

LIPKA, JOHN, MD - 1494933

WHEELER, BRUCE, MD - 1197076

STERLINGTON STERLINGTON HEALTH CLINIC PHY PEDIATRICS / FAMILY

PRACTICE

S 2 1 110 3000 AGES 0 - 6410374 HIGHWAY 165 NORTH,

SUITE D, STERLINGTON - 71280

(318)812-2304

1887200-001

BURNS, GEORGIANNA, MD - 1671631

FOUST, WILLIAM, MD - 1306941

LEWIS, TIMOTHY, NP - 1887285

WEST MONORE ROSALES CHILDRENS CLINIC PHY PEDIATRICS S 1 2 18 3000 AGES 0 - 20104 CONTEMPO AVENUE, WEST

MONORE - 71291

(318)807-1360

1794554-001

COUNTS, C MICHELLE, NP - 1432954

ROSALES, CYMANTHA, NP - 1577006

ROSALES, JR, JOAQUIN, MD - 1348597

WEST MONROE ALL KIDS R US MEDICAL CLINIC PHY PEDIATRICS / FAMILY

PRACTICE

K 2 3 3286 5500 AGES 0 - 20; ACCEPTING

AGES 0 - 16 ONLY107 CONTEMPO, SUITE B, WEST

MONROE - 71291

(318)388-5030

1448494-001

BIMLE, CYNTHIA, MD - 1697117

EDU, JENNY, NP - 1361429

MORRIS, ADDIE, NP - 1508951

SAADAT, LYNDALL, MD - 1930695

SATERFIEL, DONNA, NP - 1539899

RICHLAND

Page 188 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



DELHI DELHI RURAL HEALTH CLINIC RHC RURAL HEALTH

CLINIC

B 6 3 1524 15500 AGES 0 - 64508 BROADWAY, DELHI - 71232

(318)878-3737

1946001-001

ALBRITTON, COREY, MD - 1493589

ENRIQUEZ, JOSE, MD - 1359882

GRANDON, PAUL, MD - 1364738

HARRIS, RECEL, NP - 1469271

HAYDEN, BENJAMIN, NP - 1706671

HENSLEY, RHONDA, NP - 1548162

LE, DUNG, MD - 1935581

MCDONALD, III, KENNETH, MD - 1678503

WAGNON, CYNTHIA, MD - 1495891

MANGHAM MORGAN RONALD PHY FAMILY PRACTICE K 1 0 255 2500 AGES 0 - 64107 LELA STREET, MANGHAM -

71259

(318)248-2165

1329100-001

MANGHAM RALPH L. ABRAHAM, MD, APMC PHY FAMILY PRACTICE K 1 3 1539 3500 AGES 0 - 64261 HIGHWAY 132, MANGHAM -

71259

(318)248-2807

1444162-001

ABRAHAM, RALPH, MD - 1660612

FINLEY, HEATHER, NP - 1009687

MCDOUGAL, DEANNA, NP - 1149250

THORNTON, EULA, NP - 1434647

RAYVILLE KERR ALBERT PHY FAMILY PRACTICE K 1 0 445 2500 AGES 0 - 64121 CHRISTIAN DRIVE, RAYVILLE

- 71269

(318)728-0175

1377686-001

Page 189 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



RAYVILLE NORTHEAST LA HEALTH CENTER RHC RURAL HEALTH

CLINIC

K 5 2 1980 13500 AGES 0 - 641012 SOUTH LOUISA STREET,

RAYVILLE - 71269

(318)728-2046

1945081-001

CHISLEY, TYWANNA, MD - 1031399

DUNN, DAVID, MD - 1391735

LAFLEUR, DAN, MD - 1308994

PONARSKI, ROLAND, MD - 1967777

STRINGER, JANA, NP - 1017990

SYLVESTRI, TERRI, NP - 1536911

THOMPSON, DAVID, MD - 1318388

START START COMMUNITY CLINIC LLC RHC RURAL HEALTH

CLINIC

K 2 1 307 3000 AGES 0 - 645975 FEDERAL HIGWAY 80,

START - 71279

(318)728-4368

1450791-001

BENNETT, JENNIFER, NP - 1787141

PONARSKI, ROLAND, MD - 1967777

RUTHERFORD, W. E., MD - 1184390

TENSAS

NEWELLTON FRANKLIN MEDICAL CENTER RHC -

TENSAS

RHC RURAL HEALTH

CLINIC

K 2 7 593 1000 AGES 0 - 64104 VERONA STREET,

NEWELLTON - 71357

(318)467-9949

1440990-001

CARSON, PAIGE, NP - 1453242

COLVIN, THOMAS, MD - 1387533







YELVERTON, EMILIAMA, NP - 1623466

Page 190 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



ST. JOSEPH FRANKLIN MEDICAL CENTER RHC - ST.

JOSEPH

RHC RURAL HEALTH

CLINIC

K 1 6 273 3500 AGES 0 - 64448 NEWTON STREET, ST.

JOSEPH - 71366

(318)766-8506

1447986-001







YELVERTON, EMILIANA, NP - 1623466

ST. JOSEPH TENSAS COMMUNITY HEALTH CENTER,

INC.

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 1 120 1000 AGES 0 - 641115 LEVEE STREET, ST. JOSEPH

- 71366

(318)766-1967

1448664-001

MECHE, JOANN, NP - 1147061

NEUMANN, THOMAS, MD - 1105015

NEUMANN, JR, LEONARD, MD - 1198579

UNION

BERNICE TRI WARD CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 926 5500 AGES 0 - 64402 SECOND STREET, BERNICE -

71222

(318)285-9066

1946044-001

COX, GEORGIA, PA - 1626856

HARRIS, ROBERT, MD - 1494496

SHAW, MARK, MD - 1495611

FARMERVILLE UNION GENERAL RURAL HEALTH

CLINIC

RHC RURAL HEALTH

CLINIC

K 0 2 1074 2000 AGES 0 - 641025 MARION HIGHWAY,

FARMERVILLE - 71241

(318)368-9745

1442089-001

CASIO, RONDA, NP - 1625469

WADE, MARY, NP - 1433179

FARMERVILLE UNKEL STEVE PHY GENERAL PRACTICE K 1 0 787 2500 AGES 0 - 64811 JAMES AVENUE,

FARMERVILLE - 71241

(318)368-2238

1346985-001

Page 191 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



FARMERVILLE VENTERS STEVEN PHY INTERNAL MEDICINE K 1 0 723 2500 UNION PARISH

RESIDENTS ONLY AGES

0 - 20

811 JAMES AVENUE, SUITE B,

FARMERVILLE - 71241

(318)368-0190

1699306-001

MARION UNION CLINIC OF MARION RHC RURAL HEALTH

CLINIC

K 0 2 138 1000 AGES 0 - 643150 TAYLOR STREET, MARION -

71260

(318)292-2795

1449547-001

CASCIO, RONDA, NP - 1625469

MCDONALD, ALICE, NP - 1561142

WEST CARROLL

OAK GROVE COMMUNITY MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 1 2 395 3000 AGES 0 - 64712 SETTON, OAK GROVE - 71263

(318)428-2341

1945056-001

FAKHRE, FAKHRE, MD - 1658740

MCINTOCH, JULIE DOWLING, PA - 1624870

TILMAN, JOHN, PA - 1625094

OAK GROVE OAK GROVE MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 3 2 658 5500 AGES 0 - 64708 EAST MAIN, OAK GROVE -

71263

(318)428-3200

1943584-001

BROUSSARD, LAYNE, PA - 1627747

CHOUDHRY, KIRAN, MD - 1888699

DOMINGUE, CHRISTOPHER, MD - 1494208

JULIE DOWLING, MCINTOCH, PA - 1624870

SOWMA, SAIDI, MD - 1658758

OAK GROVE WEST CARROLL MEDICAL CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 685 5500 AGES 0 - 64502 ROSS STREET, OAK GROVE -

71263

(318)428-2358

1943941-001

ELLERBE, MISTY, PA - 1325112

GUINIGUNDO, NOLI, MD - 1367176

PORTACCI, MARK, MD - 1330957

Page 192 of 233



8REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

CALDWELL

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

1

0

0

0

0

2

0

0

2

3

0

0

0

0

1

TOTAL 3 6 6 12,516 2,055 2,110

EAST CARROLL

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

0

0

0

3

0

2

2

1

0

0

0

0

0

TOTAL 3 5 3 14,000 2,482 2,524

Page 193 of 233



8REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

FRANKLIN

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

3

0

0

1

2

0

1

1

6

0

0

0

0

1

TOTAL 6 9 23 19,500 4,578 4,642

JACKSON

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

1

0

0

0

0

2

1

0

2

1

0

0

0

0

1

TOTAL 4 4 2 11,000 2,215 2,261

Page 194 of 233



8REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

LINCOLN

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

5

3

1

0

0

1

0

5

6

5

1

0

0

0

0

TOTAL 12 17 1 17,827 6,407 6,566

MADISON

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

0

0

1

0

1

1

0

1

0

1

3

0

0

0

0

TOTAL 4 5 1 13,000 3,148 3,196

Page 195 of 233



8REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

MOREHOUSE

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

1

2

5

0

0

0

0

0

1

0

6

2

0

0

0

0

TOTAL 8 9 7 16,382 6,894 7,036

OUACHITA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

10

2

9

1

0

2

1

1

19

4

19

3

2

0

0

3

TOTAL 26 50 39 86,452 28,887 29,457

Page 196 of 233



8REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

RICHLAND

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

3

0

0

0

3

0

1

6

9

0

0

0

0

0

TOTAL 6 16 9 40,500 4,557 4,650

TENSAS

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

0

0

1

2

0

0

1

3

1

0

0

0

0

TOTAL 3 5 14 5,500 1,242 1,255

Page 197 of 233



8REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

UNION

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

1

0

1

0

0

3

0

0

1

2

1

0

0

0

0

TOTAL 5 4 5 13,500 3,855 3,954

WEST CARROLL

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

0

0

0

0

3

0

0

1

4

0

0

0

0

1

TOTAL 3 6 5 14,000 2,508 2,569

Page 198 of 233



REGION 8

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 14

12

2

23

5

0

4

23

7

0

0

2

11

26

30

60

TOTAL 83 136 115 264,177 68,828 70,220

Page 199 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



LIVINGSTON

DENHAM SPRINGS ASBAHI M. BADI PHY PEDIATRICS K 1 0 1310 2500 AGES 0 - 17303 VETERANS BOULEVARD,

SUITE C, DENHAM SPRINGS -

70726(225)664-8010

1182192-001

DENHAM SPRINGS FAMILY HEALTH OF LA / EDWIN

WALKER, MD

PHY FAMILY PRACTICE S 1 3 1194 1194 CLOSED PANEL8369 FLORIDA BOULEVARD,

SUITE 8, DENHAM SPRINGS -

70726(225)665-5149

1941000-001

BLOUNT, LAURA, NP - 1027774

PRATER, LESLIE, NP - 1564460

SMITH, KIMBERLEY, NP - 1018937

WALKER, EDWIN, MD - 1042153

DENHAM SPRINGS LPCP PEDIATRIC @ DENHAM SPRINGS

(site 036)

PHY PEDIATRICS K 4 1 2295 2295 NEWBORNS, CURRENT

PATIENTS & SIBLINGS

AGES 0 - 64


SUITE B, DENHAM SPRINGS -

70726(225)665-4554

1941913-036

CHOOJITAROM, THIRAVAT, MD - 1681580

DAVIS, TIFFANY, MD - 1019224

HART, SHANA, MD - 1484423

HOLLIS, LAURA, NP - 1620891

RAY, KAREN, MD - 1582514

DENHAM SPRINGS MASS JOSEPH PHY FAMILY PRACTICE S 1 0 41 41 CURRENT PATIENTS

AGES 4 - 64303 VETERANS BOULEVARD,

SUITE A, DENHAM SPRINGS -

70726(225)665-7785

1307793-001

DENHAM SPRINGS OCHSNER HEALTH CENTER DENHAM PHY FAMILY PRACTICE /

GENERAL PRACTICE

S 3 0 89 89 CURRENT PATIENTS &

SIBLINGS AGES 0 - 6430819 LA HIGHWAY 16, DENHAM

SPRINGS - 70726

(225)664-2029

1447609-004

DALE, ROBIN, MD - 1048445

GERMANY, ROBYN, MD - 1429333

QURESHI, ARIF, MD - 1048496

Page 200 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



DENHAM SPRINGS PEDICONS / KIDMED EAST PHY PEDIATRICS K 1 0 2505 2500 MAX CAPACITY

EXCEEDED; AGES 0 - 208369 FLORIDA BOULEVARD,

SUITE 2, DENHAM SPRINGS -

70726(225)667-2777

1947172-003

RAMADOSS, EASWAR, MD - 1468240

DENHAM SPRINGS TRIPURANENI JANNAIAH PHY INTERNAL MEDICINE K 1 0 770 770 OPEN AGES 2 - 17 & 56 -

64; CURR PTS AGES 18 -

55


SUITE A, DENHAM SPRINGS -

70726(225)667-5454

1679453-001

DENHAM SPRINGS YOUNG HENRY PHY FAMILY PRACTICE S 1 0 416 416 CLOSED PANEL1286 DEL ESTE AVENUE,

DENHAM SPRINGS - 70726

(225)667-3100

1338656-001

DENHAM SPRINGS ZGANJAR BRIAN PHY PEDIATRICS K 1 0 2137 2137 CURRENT PATIENTS AND

SIBLINGS AGES 0 - 201211 NORTH RANNGE AVENUE,

SUITE D, DENHAM SPRINGS -

70726(225)665-6677

1493546-001

LIVINGSTON BATON ROUGE FAMILY MEDICAL

CENTER

PHY FAMILY PRACTICE K 7 0 109 109 CURRENT PATIENTS

AGES 7 - 6413960 FLORIDA BOULEVARD,

LIVINGSTON - 70754

(225)686-0158

1442771-001

GASPARD, BRAD, MD - 1180807

MINSKY, LOUIS, MD - 1359416

SHAMLIN, KENYATTA, MD - 1136247

SHAMLIN, TASHA, MD - 1136344

ST. AMANT, ROBERT, MD - 1183318

TAYLOR, JAMES, MD - 1044831

TAYLOR, JAMES, MD - 1044831

Page 201 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MAUREPAS RIVERSIDE FAMILY MEDICINE, LLC RHC RURAL HEALTH

CLINIC

K 2 0 306 1000 AGES 0 - 6412489 HOME PORT DRIVE, SUITE

D, MAUREPAS - 70449

(225)698-3435

1408239-001

BENNETT, JUSTIN, MD - 1477095

BRANDT, GARY, MD - 1359670

WATSON FAMILY HEALTH OF LA / DURWIN

WALKER, MD

PHY FAMILY PRACTICE S 1 2 230 230 CLOSED PANEL34870 LA HIGHWAY 1019,

WATSON - 70706

(225)791-2000

1941000-002


ERWIN, MANDY, NP - 1332178

WALKER, DURWIN, MD - 1340499

ST. HELENA

DENHAM SPRINGS FAMILY HEATLH OF ST. HELENA, LLC RHC RURAL HEALTH

CLINIC

S 2 3 710 1000 AGES 6 MONTHS - 64

YEARS51991 HIGHWAY 16, DENHAM

SPRINGS - 70706

(225)791-3092

1459607-001


ERWIN, MANDY, NP - 1332178

GENRE, TODD, NP - 1073199

WALKER, DURWIN, MD - 1340499

WALKER, EDWIN, MD - 1042153

GREENSBURG JIMMIE W VARNADO PHY FAMILY PRACTICE B 2 2 885 6000 AGES 0 - 646214 HIGWAY 10, GREENSBURG -

70441

(225)222-3206

1443573-001

BROWN, LUBERTA, NP - 1009016

FERGUSON, LAURIE, NP - 1116076

VARNADO, ANJANETTE, MD - 1239321

VARNADO, JIMMIE, MD - 1193828

Page 202 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



GREENSBURG ST. HELENA COMMUNITY HEALTH

CENTER (site 001)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 3 1 430 5500 AGES 0 - 64490 SITMAN STREET,

GREENSBURG - 70441

(225)222-6059

1943207-001

BALLARD, CHERYL, MD - 1971936

CLEVELAND, ROBERT, MD - 1394050

COHEN, IRWIN, MD - 1303500

POPULIS, DEBRALEE, NP - 1456080

ST. TAMMANY

COVINGTON CHILDREN'S HOSPITAL MEDICAL



AGES 0 - 17728 11TH AVENUE, COVINGTON -

70433

(985)893-3395

1946711-003

FAUCHEUX, ROBERT, MD - 1484067

LOGARBO, ANTOINETTE, MD - 1984680

MIKELL, STEPHEN, MD - 1488526

STRONG, MARGARET, MD - 1331856

COVINGTON CHILDREN'S MEDICAL CENTER (site

001)

PHY PEDIATRICS K 4 1 3916 10500 AGES 0 - 1871107 HIGHWAY 21, SUITE 1,

COVINGTON - 70433

(985)893-2580

1795640-001

CASEY, SHERRI, MD - 1964441

KENNEY, KRISTEN, NP - 1507164

TERRAL, WILLIAM C, MD - 1057312

TERRAL, WILLIAM L, MD - 1164844

WILLIAMS, JOHN, MD - 1331864

COVINGTON DR. BRUCE S. SAMUELS, LLC PHY INTERNAL MEDICINE 2 0 1523 5000 AGES 21 - 64207 HIGHLAND PARK PLAZA,

COVINGTON - 70433

(985)871-8920

1795704-001

HEDGPETH, GLENN, MD - 1317667

SAMUELS, BRUCE, MD - 1146498

COVINGTON LEVI TANIA PHY INTERNAL MEDICINE 1 0 5 5 CURRENT PATIENTS

AGES 21 - 64101 EAST FAIRWAY DRIVE, SUITE

202, COVINGTON - 70433

(985)809-6195

1378054-001

Page 203 of 233


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NO. OF

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NO.

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*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



COVINGTON OCHSNER CLINIC MANDEVILLE PHY PEDIATRICS K 6 0 962 962 AGES 0 - 20; ACCEPTS


18 ONLY

101 EAST FAIRWAY APPROACH,

SUITE 302, COVINGTON - 70433

(985)809-5800

1445011-001

BAHAM, JULIE, MD - 1502812

CLOUD - NEILL, SPRING, MD - 1341142

GREMBOWICZ, MEREDITH, MD - 1488062

KARLIN, AARON, MD - 1627496

LEBLANC, JOSHUA, MD - 1116734

MIKELL, STEPHEN, MD - 1488526

COVINGTON PONTCHARTRAIN PEDIATRICS PHY PEDIATRICS K 6 0 5692 15000 AGES 0 - 184405 HIGHWAY 190 SERVICE

ROAD, COVINGTON - 70433

(985)893-8505

1442810-001

BROWN, LESLIE, MD - 1490491

GILFOUR, MELANIE, MD - 1484202

GIOE, MARY MONTE, MD - 1681849

GREENE, PATRICIA, MD - 1655106

LONDEREE, KELLY, MD - 1990311

VIDES, CARLOS, MD - 1493317

COVINGTON PUROHIT SURENDRA PHY GENERAL SURGERY 1 0 68 68 CURRENT PATIENTS

AGES 21 - 6471207 HIGHWAY 21, COVINGTON

- 70433

(985)892-6811

1159239-001

COVINGTON ROBINSON JAMES PHY INTERNAL MEDICINE 1 0 4 4 CURRENT PATIENTS

AGES 21 - 64180 GREENBRIER BOULEVARD,

COVINGTON - 70433

(985)809-7171

1979414-001

COVINGTON ST. TAMMANY PHYSICIANS NETWORK

(site 003)

PHY GENERAL PRACTICE 3 0 42 42 CURRENT PATIENTS

AGES 21 - 6480 GARDENIA DRIVE, SUITE B,

COVINGTON - 70433

(985)871-5900

1942618-003

BRINKMAN, II, ROBERT, MD - 1974072

KESLER, GLEN, MD - 1356794

MILLET, JR., J. RALPH, MD - 1144991

Page 204 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



COVINGTON STARKE ULRICH PHY INTERNAL MEDICINE 1 0 7 7 CURRENT PATIENTS

AGES 21 - 64102 HIGHLAND PARK PLAZA,

COVINGTON - 70433

(985)893-6558

1907341-001

COVINGTON WHITE ELIZABETH PHY PEDIATRICS B 1 0 181 181 CURRENT PATIENTS

AGES 0 - 18205 HIGHLAND PARK PLAZA,

COVINGTON - 70433

(985)871-8681

1986585-001

LACOMBE CHILDREN'S INTERNATIONAL (site 003) PHY PEDIATRICS K 1 1 679 3000 AGES 0 - 1727350 HIGHWAY 190 WEST,

LACOMBE - 70445

(985)882-7077

1449334-003

POUW, IN - SIAN, MD - 1100617

WITCHER, NANCY, NP - 1129151

MANDEVILLE CAPONE KEITH PHY PEDIATRICS K 1 0 13 13 CLOSED PANEL1200 WEST CAUSEWAY

APPROACH, SUITE 21,

MANDEVILLE - 70471(985)674-9331

1385999-002

MANDEVILLE DEVOE TIN TIN PHY PEDIATRICS K 1 0 1271 2500 AGES 0 - 204880 HIGHWAY 22, MANDEVILLE -

70471

(985)845-8894

1326551-001

MANDEVILLE GARAUDY (site 002) ANDREA PHY PEDIATRICS K 1 0 20 20 CLOSED PANEL1200 WEST CAUSEWAY

APPROACH, SUITE 21,

MANDEVILLE - 70471(985)674-9331

1043991-002

Page 205 of 233


REGION


CAP.

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CC

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NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



MANDEVILLE ST. TAMMANY PHYSICIANS NETWORK

(site 001)

PHY GENERAL PRACTICE B 6 0 661 661 AGES 0 - 17; CURRENT

PATIENTS AGES 18 - 64201 ST. ANN STREET, SUITE B,

MANDEVILLE - 70471

(985)626-1717

1942618-001

BAIER, CHARLES, MD - 1195065

CAPONE, KENNETH, MD - 1312151

KEEFER, LINDA, MD - 1491608

LONG, RICHARD, MD - 1459992

MASCHERPA - KERKOW, NATHALIE, MD - 1479241

MILES, JENNIFER, MD - 1492116

MANDEVILLE YOUSUF MOHAMMED PHY INTERNAL MEDICINE S 1 0 169 250 LIMITED PANEL; AGES 6 -

30; CURRENT PTS 31 - 644430 HIGHWAY 22, MANDEVILLE -

70471

(985)626-3470

1652539-001

SLIDELL CHILDREN'S INTERNATIONAL (site 001) PHY PEDIATRICS K 2 3 2814 5500 AGES 0 - 171430 LINDBERG DRIVE, SLIDELL -

70458

(985)781-7337

1449334-001

BIENVENU, JEANNE, NP - 1142620

DAKIN, JEANNE, NP - 1142620

DEMAS, REGINA, NP - 1679038

HERNANDEZ, EDUARDO, MD - 1186520

JEANSONNE, CORNEL, MD - 1347671

SLIDELL DECLOUET ALETA PHY INTERNAL MEDICINE 1 0 660 660 CURRENT PATIENTS

AGES 21 - 641340 GAUSE BOULEVARD, WEST,

SLIDELL - 70460

(985)781-7577

1534633-001

SLIDELL DUTHU ANGELA PHY PEDIATRICS K 1 0 687 687 CURRENT PATIENTS &

SIBLINGS AGES 0 - 183020 EAST GAUSE BOULEVARD,

SLIDELL - 70461

(985)726-0800

1333956-001

Page 206 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



SLIDELL HELEN E. STEVENSON, MD PHY PEDIATRICS K 2 1 2530 7500 AGES 0 - 20310 B GATEWAY DRIVE, SLIDELL

- 70461

(985)645-8687

1445592-001

FORET, CHRISTINA, NP - 1436259

MARAIA, JENNIFER, MD - 1044091

STEVENSON, HELEN, MD - 1338257

SLIDELL LARCENA ALLAN PHY INTERNAL MEDICINE S 1 0 1392 1392 CURRENT PATIENTS

AGES 14 - 64105 MEDICAL CENTER DRIVE,

SUITE 301, SLIDELL - 70461

(985)646-0123

1662097-001

SLIDELL OCHSNER CHILDREN'S HEALTH

CENTER - SLIDELL

PHY PEDIATRICS K 6 0 1078 1200 LIMITED PANEL; AGES 0 -

182370 GAUSE BOULEVARD,

SLIDELL - 70461

(985)639-3755

1445011-002

BRAUDT, STEVEN, DO - 1069566

CARTER, TRACIE, MD - 1489221

DEENEY, TARA, MD - 1043974

MAYER, JONETTE, MD - 1103161

MITCHELL, TARA, MD - 1151441

SEYMOUR, MARY, MD - 1364690

SLIDELL RAINA SANJAY PHY INTERNAL MEDICINE 1 0 30 30 CURRENT PATIENTS

AGES 21 - 641051 GAUSE BOULEVARD, SUITE

400, SLIDELL - 70458

(985)641-6882

1681881-001

SLIDELL ROHEIM JOHN PHY PEDIATRICS K 1 0 1862 2500 AGES 0 - 20105 MEDICAL CENTER DRIVE,

SUITE 202 A, SLIDELL - 70461

(985)645-8996

1933058-001

Page 207 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



SLIDELL ROWLAND SHERYL PHY PEDIATRICS K 1 0 249 249 CURRENT PATIENTS

AGES 0 - 171400 HIGHWAY 190 WEST,

SLIDELL - 70460

(985)646-1226

1907111-001

SLIDELL SMH - PHYSICIAN PRACTICE SERVICES PHY PEDIATRICS K 1 0 N/A 2500 AGES 0 - 171340 14TH STREET, SLIDELL -

70458

(985)649-8775

1945421-001

DIXIT, MADHURI, MD - 1649937

SLIDELL ST. TAMMANY COMMUNITY HEALTH

CENTER

FQHC FEDERALLY

QUALIFIED HEALTH

CLINIC

K 4 2 1886 2500 AGES 0 - 201340 14TH STREET, SLIDELL -

70458

(985)649-8775

1925349-001

DIXIT, MADHURI, MD - 1649937



NACHABE, MOUSTAFA, MD - 1990078

SADEGHPOUR, BAHRAM, MD - 1385671


TANGIPAHOA

AMITE AMITE RURAL HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 2 2 917 1000 AGES 13 MONTHS - 64

YEARS309 WEST WALNUT STREET,

AMITE - 70422

(985)748-7141

1943959-001

BROWN, LUBERTA, NP - 1009016

FUSSELL, CYNTHIA, NP - 1564028

GOLDSBY, REGINALD, MD - 1105406

RAY, DERRIS, MD - 1306533

AMITE BIGGS MAUREEN NP NURSE

PRACTITIONER

S 0 1 412 1000 AGES 1 - 64309 WEST WALNUT STREET,

SUITE A, AMITE - 70422

(985)748-9812

1550477-001

Page 208 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



AMITE CEFALU JR. NICHOLAS PHY FAMILY PRACTICE 1 0 282 2500 AGES 21 - 64112 EAST CHESTNUT STREET,

AMITE - 70422

(985)748-3272

1312886-001

AMITE MAUTERER ARTHUR PHY INTERNAL MEDICINE S 1 0 272 272 CURRENT PATIENTS AND

FAMILY MEMBERS AGES

14 - 64

309 WALNUT STREET, SUITE B,

AMITE - 70422

(985)748-5004

1037214-001

AMITE RAY DERRIS PHY FAMILY PRACTICE S 1 0 453 453 CURRENT PATIENTS

AGES 13 MONTHS - 64

YEARS

309 WALNUT STREET, SUITE D,

AMITE - 70422

(985)748-5158

1306533-001

AMITE SHAHID MUHAMMAD PHY INTERNAL MEDICINE S 1 0 532 2500 AGES 1 - 64309 WEST WALNUT STREET,

SUITE C, AMITE - 70422

(985)747-0444

1488763-001

HAMMOND CHILDREN FIRST KID MED RHC RURAL HEALTH

CLINIC

K 0 1 595 1000 AGES 0 - 201828 WEST THOMAS STREET,

HAMMOND - 70401

(985)419-2250

1020303-001

LEE, PAT, NP - 1689742

HAMMOND CHILDREN'S INTERNATIONAL (site 002) PHY PEDIATRICS K 2 1 1122 3000 AGES 0 - 17902 C. M. FAGAN DRIVE, SUITE B,

HAMMOND - 70403

(985)543-0565

1449334-002

HERNANDEZ, EDUARDO, MD - 1186520

MOODY, KRISTI, NP - 1344397

NARUMANCHI, JANANI, MD - 1455351

Page 209 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



HAMMOND HESS JAMES PHY OBGYN K 1 0 28 2500 FEMALES ONLY AGES 14

- 642101 ROBIN AVENUE, SUITE 16,

HAMMOND - 70403

(985)542-7910

1341860-001

HAMMOND LOBUE ANGELO PHY PEDIATRICS K 1 0 938 2500 AGES 0 - 1215800 PROFESSIONAL PLAZA,

HAMMOND - 70403

(985)345-2180

1081817-001

HAMMOND MURRAY, JR. WINSTON PHY INTERNAL MEDICINE S 1 0 1002 2500 AGES 0 - 64109 WEST MINNESOTA PARK,

HAMMOND - 70403

(985)542-5800

1301477-001

HAMMOND NORTH OAKS PEDIATRIC KIDMED

CLINIC (site 001)

PHY PEDIATRICS K 8 5 9396 12000 AGES 0 - 2015695 PROFESSIONAL PLAZA,

HAMMOND - 70403

(985)542-2599

1795895-001

DONNER, JR., FRANCIS, MD - 1368423

FRITZ, ELIZABETH, MD - 1074861

GRIFFIN, SUSAN, NP - 1568813

HICKEY, JR., SAMUEL, MD - 1489786

KINCHEN, LAURIE, MD - 1623156

LEUMAS, CHRIS, MD - 1339865

RHOLDON, ROGER, MD - 1196134

SCHILLAGE, MELISSA, NP - 1032034

SIMONEAUX, KIMBERLY, NP - 1370908

SMITH, SUSAN, NP - 1009407

ST. ROMAIN, JENNIFER, NP - 1369667

TRAN, JEAN, MD - 1482218

WESTMORELAND, L. R., MD - 1188271

Page 210 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



HAMMOND NORTH OAKS PEDIATRIC KIDMED

CLINIC (site 002)

PHY PEDIATRICS K 7 6 3347 9000 AGES 0 - 2015760 MEDICAL ARTS PLAZA,

HAMMOND - 70403

(985)542-8599

1795895-002

DONNER, FRANCIS, MD - 1368423

FRITZ, ELIZABETH, MD - 1074861

GRIFFIN, SUSAN, NP - 1568813

HICKEY, JR, SAMUEL, MD - 1489786

KINCHEN, LAURIE, NP - 1623156

LEUMAS, CHRIS, MD - 1339865

RHOLDON, ROGER, MD - 1196134

SCHILLAGE, MELISSA, NP - 1032034

SIMONEAUX, KIMBERLY, NP - 1370908

SMITH, SUSAN, NP - 1009407

ST. ROMAIN, JENNIFER, NP - 1369667

TRAN, JEAN, MD - 1482218

WESTMORELAND, LEO, MD - 1188271

HAMMOND NORTH OAKS SPECIALITY CLINICS (site

001)


GENERAL PRACTICE

S 5 0 295 295 CURRENT PATIENTS &

FUTURE SIBLINGS AGES

1 - 64

1902 SOUTH BOULEVARD,

HAMMOND - 70403

(985)230-5800

1447587-001

DRAPCHO, MICHAEL, MD - 1916871

GUILBAULT, III, ROBERT, MD - 1541907

RAPHAEL, HOWARD, MD - 1902411

SPILLER, EDMUND, MD - 1327280

VALDES, HUGO, MD - 1544839

HAMMOND OVERTON JOHN PHY PEDIATRICS K 1 0 821 2500 AGES 0 - 2016031 DEBLIN SQUARE HIGHWAY

51 SOUTH, HAMMOND - 70403

(985)386-9911

1301701-001

HAMMOND WILLIAMS CLIFFORD PHY INTERNAL MEDICINE 1 0 614 2500 AGES 21 - 642101 ROBIN AVENUE, SUITE 14,

HAMMOND - 70403

(985)345-0777

1304328-001

Page 211 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



INDEPENDENCE GENOVESE CHARLES PHY INTERNAL MEDICINE 1 0 579 2500 AGES 21 - 64312 EAST RAILROAD AVENUE,

INDEPENDENCE - 70443

(985)878-4183

1335681-001

INDEPENDENCE LALLIE KEMP HOSPITAL CLINICS PHY MULTI - SPECIALTY

CLINIC

B 12 5 1927 19500 AGES 2 MONTHS - 64

YEARS52579 HIGHWAY 51 SOUTH,


(985)878-1500

1940046-001

ANANTH, MAMATHA, MD - 1498483

BROUSSARD, AMY, MD - 1574929

DILDY, GARY, MD - 1134473

GALLIEN, ABBEY, MD - 1672971

GREEN, STACEY, MD - 1424196

JOHNSON, JUANTINA, MD - 1064939

KAHLID - ABASI, DEBRA, NP - 1620963

LAMPRECHT, CARL, MD - 1901270

LINTON, DENISE, NP - 1106518

PARETTI, SHAROLYN, NP - 1561614

REHMAN, MATLOOB, MD - 1476421

RICKS, VERONICA, NP - 1119512

SHEIKH, MOHAMMED, MD - 1104281

VON ALMEN, BIVIN, MD - 1930946

WHALEY, WENDY, NP - 1180840

WILHLOW, FRANK, MD - 1065242

WILLIS, KATHLENN, MD - 1576921

INDEPENDENCE MULTIPRACTICE CLINIC FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

K 2 1 2007 5500 AGES 0 - 64281 WEST 4TH STREET,


(985)878-0066

1448109-001

DALFERES, PATRICIA, NP - 1141232

DAVIS, MARVETTA, MD - 1697761

KESHELAVA, GEORGE, MD - 1075914

Page 212 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



KENTWOOD ST. HELENA COMMUNITY HEALTH

CENTER (site 005)

FQHC FEDERALLY

QUALIFIED HEALTH

CENTER

S 2 0 565 5000 AGES 6 MONTHS- 64

YEARS721 AVENUE G, KENTWOOD -

70444

(985)229-5501

1943207-005


FALLER, CARLTON, MD - 1032107

PONCHATOULA ALLENS FAMILY PRACTICE CLINIC PHY FAMILY PRACTICE B 2 0 303 303 CURRENT PATIENTS

AGES 0 - 64105 EAST OAK STREET,

PONCHATOULA - 70454

(985)386-6198

1950009-001

ALLEN, GREGORY, MD - 1379697

GAUDIN, STEVE, MD - 1681687

WASHINGTON

BOGALUSA CAILLOUET GILBERT PHY GENERAL PRACTICE 1 0 7 7 CURRENT PATIENTS

AGES 21 - 641616 SOUTH COLUMBIA,

BOGALUSA - 70429

(985)735-7335

1042269-001

BOGALUSA CASAMA ROGER PHY INTERNAL MEDICINE 1 0 370 2500 AGES 21 - 642807 SOUTH COLUMBIA STREET,

BOGALUSA - 70429

(985)735-8382

1106755-001

BOGALUSA FEINBERG JILL PHY FAMILY PRACTICE K 1 0 515 2500 AGES 0 - 641415 AVENUE F, BOGALUSA -

70427

(985)735-1198

1365858-001

Page 213 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BOGALUSA LSU - WASHINGTON ST. TAMMANY

REGIONAL MEDICAL CENTER


CLINIC

2 1 265 5000 AGES 21 - 64400 MEMPHIS STREET,

BOGALUSA - 70427

(985)730-7193

1940011-001

DIXIT, DEEPAK, MD - 1650897

HEBERT, GLYNN, MD - 1099872

WASCOM, PATTI, NP - 1694207



PHY PEDIATRICS K 4 0 1190 5000 AGES 0 - 20712 WILLIS AVENUE, SUITE 4,

BOGALUSA - 70427

(985)730-2061

1940011-006

AITA - LEVY, JERUSSA, MD - 1434973

GASTANADUY, ARTURO, MD - 1956023

MANGAT, RAGHUBIR, MD - 1331007

MOUALLEM, RAJA, MD - 1330990




GENERAL PRACTICE

K 5 1 107 10000 AGES 0 - 64420 AVENUE F, BOGALUSA -

70427

(985)732-0058

1940011-007

CAIN, ELIZABETH, MD - 1650960

CROOKS, WILLIAM, MD - 1111821

FRIEND, RICHARD, MD - 1655902

LAMARTINA, JR, JOHN, MD - 1308269

MCBRIDE, DOUGLAS, MD - 1470121

SMITH, MONICA, NP - 1317403

BOGALUSA PEDIATRIC CLINIC, THE PHY PEDIATRICS K 1 1 2494 3000 AGES 0 - 64405 AVENUE F, BOGALUSA -

70429

(985)732-1568

1947717-001

HEAD, TINA, NP - 1721603

PALAZZO, ANTHONY, MD - 1367061

BOGALUSA TABARI HOSSEIN PHY INTERNAL MEDICINE 1 0 90 90 CURRENT PATIENTS

AGES 21 - 641616 SOUTH COLUMBIA STREET,

SUITE E, BOGALUSA - 70427

(985)735-7810

1350443-001

Page 214 of 233


REGION


CAP.

CURRENT

CC

LINKAGE

NO. OF

PHYS.

EXT.

NO.

OF

PHYS.

*

KM

SVC

PROVIDER

SPECIALTY

PROV.

TYPE



BOGALUSA THERIAULT VICTOR PHY FAMILY PRACTICE 1 0 14 14 CURRENT PATIENTS

AGES 21 - 64712 WILLIS AVENUE, BOGALUSA -

70427

(985)732-4853

1181251-001

BOGALUSA YERNENI PURNACHANDRA PHY INTERNAL MEDICINE K 1 0 460 2500 AGES 6 - 641011 AVENUE F, BOGALUSA -

70427

(985)732-9940

1969966-001

FRANKLINTON ALVARADO LUIS PHY INTERNAL MEDICINE 1 0 57 57 CURRENT PATIENTS

AGES 21 - 6421012 HIGHWAY 16,

FRANKLINTON - 70438

(985)795-0500

1994715-001

FRANKLINTON FRANKLINTON RURAL HEALTH CLINIC RHC RURAL HEALTH

CLINIC

K 2 1 1104 3000 AGES 0 - 642004 J MARVIN MAGEE DRIVE,

FRANKLINTON - 70438

(985)839-3555

1440451-001

CEFALU, FRANCIS, MD - 1355640

THOMAS, JERRY, MD - 1321044

WHEELER, GWEN, NP - 1103489

FRANKLINTON LSU - WASHINGTON ST. TAMMANY


PHY FAMILY PRACTICE K 2 1 684 5500 AGES 0 - 6451704 HIGHWAY 438,

FRANKLINTON - 70438

(985)848-9955

1940011-005

CAIN, ELIZABETH, MD - 1650960

THOMAS, JERRY, MD - 1321044

WILLIAMS, JANICE, PA - 1624969

Page 215 of 233



9REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

LIVINGSTON

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

4

1

6

0

0

0

1

0

5

2

15

2

0

0

0

0

TOTAL 12 24 6 13,281 16,997 17,392

ST. HELENA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

0

0

1

0

0

1

1

0

1

0

6

0

0

0

0

0

TOTAL 3 7 6 12,500 1,580 1,607

Page 216 of 233



9REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

ST. TAMMANY

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

16

8

0

2

0

0

0

2

38

15

2

1

0

0

0

6

TOTAL 28 62 8 63,427 25,579 26,210

TANGIPAHOA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

5

5

4

0

1

2

2

2

22

12

13

1

2

0

0

2

TOTAL 21 52 22 78,323 25,167 25,586

Page 217 of 233



9REGION

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

WASHINGTON

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

2

4

4

1

0

0

1

1

5

6

8

4

0

0

0

0

TOTAL 13 23 5 39,168 9,205 9,382

Page 218 of 233



REGION 9

CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

MAXIMUM

CAPACITY

NUMBER OF

PHYSICIAN

EXTENDERS

NUMBER OF

COMMUNITYCARE

PHYSICIANS

NUMBER OF

COMMUNITYCARE

PROVIDERS

SPECIALTYPARISH

REGION TOTALS

OTHER

RHC

FQHC

OB/GYN

GENERAL PRACTICE

FAMILY PRACTICE

INTERNAL

PEDIATRICS 27

18

5

5

3

1

3

15

8

0

0

2

8

35

71

44

TOTAL 77 168 47 206,699 78,528 80,177

Page 219 of 233


CURRENT CC

ELIGIBLES

TOTAL

CURRENT CC

LINKAGES

TOTAL

TOTAL

MAXIMUM

CAPACITY

TOTAL

PHYSICIAN

EXTENDERS

TOTAL

COMMUNITYCARE

PHYSICIANS

TOTAL

COMMUNITYCARE

PROVIDERS

PROVIDER TYPE

CommunityCare Provider and Physician Totals for the State of Louisiana

STATE OF LOUISIANA

PEDIATRICS

INTERNAL

FAMILY PRACTICE

GENERAL PRACTICE

OB/GYN

FQHC

RHC

OTHER

243

12

0

0

54

26

197

151

590

319

495

123

100

52

49

99

TOTAL 500 2,325,735 1,679 831 738,968 756,199

Page 220 of 233


KIDMED Providers by Parish

Region 1

RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH

JEFFERSON-EAST BANK

JEFFERSON RIVERDALE HIGH SBHC SBHC1015407-001

METAIRIE BUNCHE SBHC SBHC1446467-001

METAIRIE JEFFERSON HEALTH UNIT - METAIRIE PHC1410004-211

JEFFERSON-WEST BANK

HARVEY WEST JEFFERSON SBHC SBHC1141020-001

MARRERO JEFFERSON HEALTH UNIT PHC1410004-055

WESTWEGO BUTLER SBHC SBHC1446491-001

ORLEANS

NEW ORLEANS ELEANOR MCMAIN SECONDARY SBHC SBHC1351482-001

NEW ORLEANS MCLNO O PERRY WALKER SBHC SBHC1031691-001

NEW ORLEANS NEW ORLEANS CHARTER SCIENCE & MATH SBHC SBHC1340821-001

NEW ORLEANS TUHC DOWNTOWN PEDIATRIC CLINIC (site 006) PHY1444910-006

PLAQUEMINES

BELLE CHASSE PLAQUEMINES PARISH SCHOOL BOARD LEA1415227-001

ST. BERNARD

CHALMETTE CHALMETTE HIGH SCHOOL SBHC1039691-001

CHALMETTE ST. BERNARD HEALTH UNIT PHC1410004-217

Page 221 of 233



Region 2


ASCENSION

DONALDSONVILLE ASCENSION HEALTH UNIT - DONALDSONVILLE PHC1410004-215

DONALDSONVILLE ASCENSION PARISH SCHOOL BOARD LEA1415090-001

GONZALES ASCENSION PARISH GOVERNMENT PFSC1417254-001

EAST BATON ROUGE

BATON ROUGE ADVANCED COMPREHENSIVE TESTING PHY1943088-004

BATON ROUGE EAST BATON ROUGE HEALTH UNIT PHC1410004-218

BATON ROUGE HCCS CAPITOL HIGH SBHC SBHC1446271-001

BATON ROUGE HCCS GLEN OAKS HIGH SBHC SBHC1446335-001

BATON ROUGE HCCS GLEN OAKS MIDDLE SBHC SBHC1446254-001

BATON ROUGE HCCS ISTROUMA HIGH SBHC SBHC1446327-001

BATON ROUGE HCCS PRESCOTT MIDDLE SBHC SBHC1446262-001

BATON ROUGE HCCS WESTDALE MIDDLE SBHC SBHC1446289-001

BATON ROUGE SOUTHERN UNIV. SCH. OF NURSING NURSE MNGD. FAMILY

HLTH CARE

PFSC1416886-001

PRIDE HCCS NORTHEAST ELEMENTARY SBHC SBHC1446297-001

PRIDE HCCS NORTHEAST HIGH SBHC SBHC1446301-001

ZACHARY MED AMERICA PFSC1416142-001

EAST FELICIANA

CLINTON EAST FELICIANA HEALTH UNIT PHC1410004-094

Page 222 of 233



Region 2


IBERVILLE

PLAQUEMINE IBERVILLE HEALTH UNIT PHC1410004-017

ST. GABRIEL EAST IBERVILLE ELEMENTARY / HIGH SBHC FQHC1457680-001

POINTE COUPEE

MORGANZA POINTE COUPEE CENTRAL HIGH SCHOOL BASED HEALTH

CENTER

SBHC AGES 4 - 201034185-001

NEW ROADS POINTE COUPEE HEALTH UNIT PHC1410004-092

WEST BATON ROUGE

PORT ALLEN WEST BATON ROUGE HEALTH UNIT PHC1410004-015

WEST FELICIANA

ST. FRANCISVILLE FAMILY SERVICE CENTER SBHC SBHC1447081-001

ST. FRANCISVILLE WEST FELICIANA HEALTH UNIT PHC1410004-096

Page 223 of 233



Region 3


ASSUMPTION

NAPOLEONVILLE ASSUMPTION PARISH HEALTH UNIT PHC1410004-052

LAFOURCHE

GALLIANO LAFOURCHE HEALTH UNIT - GALLIANO PHC1410004-192

THIBODAUX LAFOURCHE HEALTH UNIT - THIBODAUX PHC1410004-064

ST. JAMES

VACHERIE ST. JAMES HEALTH UNIT - VACHERIE PHC1410004-075

ST. JOHN

RESERVE ST. JOHN HEALTH UNIT - RESERVE PHC1410004-076

ST. MARY

MORGAN CITY ST. MARY HEALTH UNIT - MORGAN CITY PHC1410004-127

TERREBONNE

HOUMA TERREBONNE HEALTH UNIT PHC1410004-078

Page 224 of 233



Region 4


ACADIA

CHURCHPOINT ACADIA - ST. LANDRY HOSPITAL PFSC1416002-001

RAYNE ACADIA PARISH POLICE JURY - COMMUNITY PFSC1410705-001

EVANGELINE

VILLE PLATTE EVANGELINE SCHOOL BOARD LEA1415405-001

LAFAYETTE

LAFAYETTE CHILDREN'S HEALTH CARE CLINIC OF ACADIANA PHY1944131-001

LAFAYETTE NORTHSIDE HIGH SBHC SBHC1446483-001

LAFAYETTE UNIVERSITY MEDICAL CENTER PFSC1416746-001

ST. LANDRY

OPELOUSAS CHILDREN'S KIDMED CLINIC, INC. PFSC1416363-001

SUNSET ST. LANDRY PARISH POLICE JURY PFSC1417211-001

ST. MARTIN

BREAUX BRIDGE BREAUX BRIDGE SBHC SBHC1446432-001

BREAUX BRIDGE ST. MARTIN PARISH GOVERNMENT - BREAUX BRIDGE PFSC1417238-001

BREAUX BRIDGE ST. MARTIN PARISH GOVERNMENT - CECILIA PFSC1417238-002

CECILIA CECILIA SCHOOL BASED HEALTH CENTER SBHC1446441-001

ST. MARTINVILLE ST. MARTINVILLE SBHC SBHC1446424-001

Page 225 of 233



Region 5


ALLEN

OAKDALE ALLEN HEALTH UNIT - OAKDALE PHC1410004-136

OAKDALE OAKDALE SCHOOL BASED HEALTH CENTER SBHC1446360-001

BEAUREGARD

DERIDDER BEAUREGARD HEALTH UNIT PHC1410004-138

CALCASIEU

LAKE CHARLES CALCASIEU HEALTH UNIT - LAKE CHARLES PHC1410004-134

LAKE CHARLES CLIFTON ELEMENATRY SBHC SBHC1447731-001

LAKE CHARLES COMBRE - FONDEL ELEMENTARY SBHC SBHC1447749-001

LAKE CHARLES M & M FAMILY CLINIC PFSC1308846-001

LAKE CHARLES MOLO MIDDLE SBHC SBHC1447161-001

LAKE CHARLES WASHINGTON - MARION SBHC SBHC1447153-001

SULPHUR CALCASIEU HEALTH UNIT - SULPHUR PHC1410004-135

CAMERON

CAMERON CAMERON HEALTH UNIT - CAMERON PHC1410004-196

HACKBERRY CAMERON HEALTH UNIT - HACKBERRY PHC1410004-234

JEFFERSON DAVIS

JENNINGS JEFFERSON DAVIS HEALTH UNIT PHC1410004-033

Page 226 of 233



Region 6


AVOYELLES

MANSURA AVOYELLES CHARTER SBHC SBHC1446939-001

MANSURA AVOYELLES SBHC SBHC1446921-001

CATAHOULA

JONESVILLE CATAHOULA HEALTH UNIT - JONESVILLE PHC1410004-046

CONCORDIA

FERRIDAY CONCORDIA HEALTH UNIT - FERRIDAY PHC1410004-044

GRANT

COLFAX GRANT HEALTH UNIT PHC1410004-041

DRY PRONG GRANT SBHC SBHC1446971-001

POLLOCK POLLOCK SBHC SBHC1446866-001

LASALLE

JENA JENA HIGH SBHC SBHC1446963-001

JENA JENA JR. HIGH SBHC SBHC1446874-001

JENA LASALLE HEALTH UNIT - JENA PHC1410004-042

Page 227 of 233



Region 6


RAPIDES

ALEXANDRIA FAMILY MEDICINE CENTER - ALEXANDRIA PEDIATRICS PHY1445266-002

ALEXANDRIA HUEY P. LONG KIDMEDICAL CENTER PFSC1416878-001

ALEXANDRIA RAPIDES HEALTH UNIT PHC1410004-012

DEVILLE BUCKEYE SBHC SBHC1446947-001

GLENMORA GLENMORA SBHC SBHC1446955-001

LENA NORTHWOOD SBHC SBHC1446882-001

PINEVILLE LESSIE MOORE SBHC SBHC1446858-001

PINEVILLE PINEVILLE JR. HIGH SBHC SBHC1446904-001

PINEVILLE TIOGA HIGH SBHC SBHC1446840-001

PINEVILLE TIOGA JR. HIGH SBHC SBHC1446912-001

VERNON

LEESVILLE VERNON HEALTH UNIT PHC1410004-048

WINN

WINNFIELD WINN HEALTH UNIT PHC1410004-090

Page 228 of 233



Region 7


BIENVILLE

ARCADIA BIENVILLE HEALTH UNIT - ARCADIA PHC1410004-088

BOSSIER

BOSSIER CITY BOSSIER HEALTH UNIT - BOSSIER PHC1410004-021

CADDO

SHREVEPORT ATKINS SBHC SBHC1446416-001

SHREVEPORT CADDO HEALTH UNIT - SHREVEPORT PHC1410004-171

SHREVEPORT LINWOOD SCHOOL BASED HEALTH CENTER SBHC1446394-001

SHREVEPORT WOODLAWN SBHC SBHC1039896-001

CLAIBORNE

HOMER CLAIBORNE HEALTH UNIT PHC1410004-098

DESOTO

MANSFIELD DESOTO HEALTH UNIT PHC1410004-038

NATCHITOCHES

CAMPTI NATCHITOCHES SBHC SBHC1446815-001

NATCHITOCHES NATCHITOCHES CENTRAL SBHC SBHC1446807-001

NATCHITOCHES NATCHITOCHES HEALTH UNIT PHC1410004-043

RED RIVER

COUSHATTA COUSHATTA KIDMED, LLC PFSC1417246-001

COUSHATTA RED RIVER HEALTH UNIT PHC1410004-034

Page 229 of 233



Region 7


SABINE

MANY SABINE HEALTH UNIT PHC1410004-036

WEBSTER

MINDEN WEBSTER HEALTH UNIT - MINDEN PHC1410004-011

SPRINGHILL WEBSTER HEALTH UNIT - SPRINGHILL PHC1410004-010

Page 230 of 233



Region 8


CALDWELL

COLUMBIA CALDWELL HEALTH UNIT PHC1410004-108

COLUMBIA COUGHRAN MEDICAL CORPORATION (site 002) PHY1449130-002

EAST CARROLL

LAKE PROVIDENCE EAST CARROLL HEALTH UNIT PHC1410004-032

FRANKLIN

WINNSBORO FRANKLIN HEALTH UNIT PHC1410004-105

JACKSON

JONESBORO JACKSON HEALTH UNIT PHC1410004-106

JONESBORO JACKSON PARISH HOSPITAL SBHC SBHC1447277-001

LINCOLN

RUSTON LINCOLN HEALTH UNIT PHC1410004-031

MADISON

TALLULAH MADISON HEALTH UNIT PHC1410004-103

TALLULAH MADISON SENIOR HIGH SCHOOL SBHC1446343-001

MOREHOUSE

BASTROP MOREHOUSE HEALTH UNIT PHC1410004-110

Page 231 of 233



Region 8


OUACHITA

MONROE NORTHEAST RURAL HEALTH CENTER PHY1947695-003

MONROE OUACHITA HEALTH UNIT PHC1410004-101

MONROE ST. FRANCIS SBHC SBHC1034142-001

WEST MONORE WEST MONROE SBHC SBHC1335029-001

WEST MONROE RISER SBHC SBHC1446181-001

RICHLAND

DELHI RICHLAND PARISH HOSPITAL SBHC SBHC1446459-001

RAYVILLE RICHARDSON MEDICAL CENTER SBHC SBHC1033952-001

RAYVILLE RICHLAND HEALTH UNIT PHC1410004-104

TENSAS

ST. JOSEPH TENSAS HEALTH UNIT - ST. JOSEPH PHC1410004-114

UNION

FARMERVILLE UNION HEALTH UNIT PHC1410004-112

WEST CARROLL

OAK GROVE WEST CARROLL HEALTH UNIT PHC1410004-102

Page 232 of 233



Region 9


LIVINGSTON

LIVINGSTON LIVINGSTON HEALTH UNIT - LIVINGSTON PHC1410004-084

ST. HELENA

GREENSBURG ST. HELENA COMMUNITY HEALTH CENTER (site 002) FQHC AGES 9 - 151943207-002

GREENSBURG ST. HELENA COMMUNITY HEALTH CENTER (site 003) PFSC1943207-003

GREENSBURG ST. HELENA COMMUNITY HEALTH CENTER (site 004) PFSC1943207-004

GREENSBURG ST. HELENA HEALTH UNIT PHC1410004-082

ST. TAMMANY

COVINGTON COMMUNITY WELLNESS CENTER PFSC1410543-001

TANGIPAHOA

AMITE TANGIPAHOA HEALTH UNIT - AMITE PHC1410004-204

HAMMOND TANGIPAHOA HEALTH UNIT - HAMMOND PHC1410004-085

WASHINGTON

BOGALUSA BOGALUSA HIGH SBHC SBHC1447714-001

BOGALUSA BOGALUSA JR. HIGH SBCH SBHC1447706-001

Page 233 of 233

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