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
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
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,
SUITE 120, KENNER - 70065
(504)464-8683
1307505-001
KENNER GELMAN VADIM PHY OBGYN 1 0 89 2500 FEMALES ONLY, AGES 21
- 40200 WEST ESPLANADE AVENUE,
SUITE 314, KENNER - 70065
(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,
SUITE 205, KENNER - 70065
(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,
SUITE 201, KENNER - 70065
(504)305-0063
1662101-001
Page 2 of 233
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
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,
SUITE 490, KENNER - 70062
(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
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
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,
SUITE 203, KENNER - 70065
(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,
SUITE 314, KENNER - 70065
(504)464-8750
1323004-001
Page 4 of 233
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
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
METAIRIE CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 007)
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
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
METAIRIE CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 009)
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
METAIRIE CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 011)
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,
SUITE 340, METAIRIE - 70002
(504)309-9364
1940305-001
BEVROTTE, LOUIS, MD - 1135640
BURAS, JR., FLOYD, MD - 1168548
LE BOUEF, RICHARD, MD - 1144835
Page 6 of 233
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
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
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
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,
SUITE 208, METAIRIE - 70003
(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
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
METAIRIE SUNRISE PEDIATRICS PHY PEDIATRICS K 4 0 600 600 CURRENT PATIENTS,
NEWBORNS, & SIBLINGS
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,
SUITE 101, METAIRIE - 70002
(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
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
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
ABDALIAN, SUSAN, MD - 1372480
ALCHEDIAK, THOMAS, MD - 1367737
DOUCET, III, HOSEA, MD - 1194891
KNIGHT, KATHERINE, MD - 1155055
SILIO, MARGARITA, MD - 1983535
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
PRACTICE CORP (site 008)
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
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
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
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
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
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
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
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
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
Page 14 of 233
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
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
Page 15 of 233
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
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
50, NEW ORLEANS - 70115
(504)891-1800
1320714-001
NEW ORLEANS BARNES SHELTON PHY INTERNAL MEDICINE S 1 0 563 2500 AGES 15 - 643600 PRYTANIA STREET, SUITE
50, NEW ORLEANS - 70115
(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
Page 16 of 233
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
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
PRACTICE CORP (site 002)
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
NEW ORLEANS CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 006)
PHY PEDIATRICS K 6 0 3121 5000 AGES 0 - 202820 NAPOLEON AVENUE, SUITE
950, NEW ORLEANS - 70115
(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
NEW ORLEANS CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 012)
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
NEW ORLEANS CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 015)
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
Page 17 of 233
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
NEW ORLEANS CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 016)
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
NEW ORLEANS CHILDREN'S HOSPITAL MEDICAL
PRACTICE CORP (site 017)
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
540, NEW ORLEANS - 70127
(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
Page 18 of 233
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
NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site
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
NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site
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
NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site
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
NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site
009)
PHY INTERNAL MEDICINE S 1 0 321 321 CURRENT PATIENTS
AGES 14 - 643701 BEHRMAN PLACE, SUITE
1100, NEW ORLEANS - 70114
(504)367-6971
1943479-009
CURRIE, EVITA, MD - 1307262
NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site
010)
PHY FAMILY PRACTICE S 2 0 278 278 CLOSED PANEL9801 LAKE FORREST
BOULEVARD, NEW ORLEANS -
70127(504)246-1452
1943479-010
COOPER, MICHELE, MD - 1693570
LABRANCHE, EMILE, MD - 1364843
NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site
011)
PHY INTERNAL MEDICINE S 1 0 96 100 AGES 14 - 643434 PRYTANIA STREET, SUITE
110, NEW ORLEANS - 70115
(504)897-7007
1943479-011
BERTSCH, JENNIFER, MD - 1483087
Page 19 of 233
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
NEW ORLEANS CRESCENT CITY PHYSICIANS, INC. (site
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
620, NEW ORLEANS - 70115
(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
BOULEVARD, NEW ORLEANS -
70124(504)283-7306
1043991-001
Page 20 of 233
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
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
Page 21 of 233
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
NEW ORLEANS LOUISIANA HEALTHCARE INITIATIVE,
LLC
PHY INTERNAL MEDICINE /
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
890, NEW ORLEANS - 70115
(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
Page 22 of 233
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
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,
SUITE 202, NEW ORLEANS -
70114(504)368-4066
1443263-001
DREZ, CHERIE, MD - 1483931
YURATICH, PAUL, MD - 1916609
NEW ORLEANS MCLNO - FREDERICK DOUGLAS
SENIOR HIGH SCHOOL
PHY MULTI - SPECIALTY
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
Page 23 of 233
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
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
BACON, GLORIA, MD - 1010375
BOURGEOIS, LIONEL, MD - 1656801
BROUSSARD, MARY, NP - 1030210
CHATMAN, PATRICIA, 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, EMILIO, MD - 1345679
WILLIAMS, SHONDRA, NP - 1106836
YOURMAN, CASSANDRA, MD - 1392952
Page 24 of 233
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
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
BACON, GLORIA, MD - 1010375
BOURGEOIS, LIONEL, MD - 1656801
BROUSSARD, MARY, NP - 1030210
CHATMAN, PATRICIA, 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, EMILIO, MD - 1345679
WILLIAMS, SHONDRA, NP - 1106836
YOURMAN, CASSANDRA, MD - 1392952
Page 25 of 233
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
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
BACON, GLORIA, MD - 1010375
BOURGEOIS, LIONEL, MD - 1656801
BROUSSARD, MARY, NP - 1030210
CHATMAN, PATRICIA, 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, EMILIO, MD - 1345679
WILLIAMS, SHONDRA, NP - 1106836
YOURMAN, CASSANDRA, MD - 1392952
NEW ORLEANS MCLNO / TULANE - MEDICINE GROUP
(site 002)
PHY INTERNAL MEDICINE 7 0 201 5000 AGES 21 - 641450 POYDRAS AVENUE, 3RD
FLOOR, NEW ORLEANS - 70112
(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
Page 26 of 233
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
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
ALCHEDIAK, THOMAS, MD - 1367737
SILIO, MARGARITA, MD - 1983535
NEW ORLEANS MCNEIL KIMBERLY PHY PEDIATRICS K 1 0 1354 2500 AGES 0 - 205640 READ BOULEVARD, SUITE
475, NEW ORLEANS - 70127
(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
220, NEW ORLEANS - 70115
(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,
SUITE 100, NEW ORLEANS -
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
Page 27 of 233
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
NEW ORLEANS NO / AIDS TASK FORCE PHY INFECTIOUS DISEASE
/ FAMILY PRACTICE
S 1 2 58 3500 AGES 18 - 642601 TULANE AVENUE, SUITE
500, NEW ORLEANS - 70119
(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
FLOOR, NEW ORLEANS - 70113
(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
FLOOR, NEW ORLEANS - 70113
(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
Page 28 of 233
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
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,
SUITE 103, NEW ORLEANS -
70114(504)365-9906
1576794-001
Page 29 of 233
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
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
ALCHEDIAK, THOMAS, MD - 1367737
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
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
NEW ORLEANS TULANE DOWNTOWN GENERAL
PEDIATRICS
PHY PEDIATRICS S 4 0 98 2500 AGES 0 - 201415 TULANE AVENUE, 5TH
FLOOR, NEW ORLEANS - 70112
(504)988-6253
1443719-016
ALCHEDIAK, THOMAS, MD - 1367737
KNIGHT, KATHERINE, MD - 1155055
SILIO, MARGARITA, MD - 1983535
WEIMER, STEPHEN, MD - 1662003
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
ABDALIAN, SUSAN, MD - 1372480
ALCHEDIAK, THOMAS, MD - 1367737
BONIN, EDWARD, NP - 1693065
DISE, THERESA, MD - 1378291
DOUCET, III, HOSEA, MD - 1194891
FINGER, JULIE, MD - 1464023
SILIO, MARGARITA, MD - 1983535
WEIMER, STEPHEN, MD - 1662003
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
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
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
ALCHEDIAK, THOMAS, MD - 1367737
DISE, THERESA, MD - 1378291
NEW ORLEANS TULANE UNIVERSITY COMMUNITY
HEALTH CENTER (site 012)
PHY INTERNAL MEDICINE /
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
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
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
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
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
ACS Government Healthcare Solutions
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
ACS Government Healthcare Solutions
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
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
ACS Government Healthcare Solutions
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
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both2
CommunityCARE Provider Count by Parish
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
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 - Both2
CommunityCARE Provider Count by Parish
GONZALES ST. ELIZABETH PHYSICIANS (site 001) PHY PEDIATRICS K 5 3 1631 1631 CURRENT PATIENTS
AGES 0 - 642647 SOUTH ST. ELIZABETH
BOULEVARD, SUITE 100,
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
BOULEVARD, SUITE 316,
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
K 2 0 413 413 CURRENT PATIENTS
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
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 - Both2
CommunityCARE Provider Count by Parish
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
K 8 2 437 437 CURRENT PATIENTS
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
K 2 1 139 139 CURRENT PATIENTS
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
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 - Both2
CommunityCARE Provider Count by Parish
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
PHY INTERNAL MEDICINE /
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
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 - Both2
CommunityCARE Provider Count by Parish
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
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 - Both2
CommunityCARE Provider Count by Parish
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
325, BATON ROUGE - 70806
(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
PHY FAMILY PRACTICE /
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
100, BATON ROUGE - 70810
(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
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 - Both2
CommunityCARE Provider Count by Parish
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
Page 45 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
Page 46 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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,
SUITE 7000, BATON ROUGE -
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
Page 47 of 233
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 - Both2
CommunityCARE Provider Count by Parish
BATON ROUGE LPCP PEDIATRICS AT GOODWOOD (site
027)
PHY PEDIATRICS K 6 3 10182 10182 AGES 0 - 5; CURRENT
PTS & SIBLINGS AGES 6 -
18
8415 GOODWOOD BOULEVARD,
SUITE 100, BATON ROUGE -
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
Page 48 of 233
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 - Both2
CommunityCARE Provider Count by Parish
BATON ROUGE LPCP SOUTHEAST PEDIATRICS (site
012)
PHY PEDIATRICS K 5 1 3332 3332 OPEN AGES 0 - 2;
CURRENT PTS &
SIBLINGS AGES 3 -20
8415 GOODWOOD BOULEVARD,
SUITE 104, BATON ROUGE -
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
TALBOT, AMANDA, MD - 1170771
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
HOWE, JOHN, MD - 1196002
LUKE, LEELA, MD - 1328243
ROSCOE, NARKITA, NP - 1316032
VENTERS, CHARMAINE, MD - 1974269
WOODARD, TRACI, MD - 1044130
Page 49 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
HOWE, JOHN, MD - 1196002
ZHENG, YIHONG, MD - 1493554
BATON ROUGE MAYO TAMIKA PHY FAMILY PRACTICE S 1 0 938 2500 AGES 1 - 643401 NORTH BOULEVARD, SUITE
360, BATON ROUGE - 70806
(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
Page 50 of 233
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 - Both2
CommunityCARE Provider Count by Parish
BATON ROUGE MURRILL MELVIN PHY PEDIATRICS S 1 0 2194 2500 AGES 0 - 204560 NORTH BOULEVARD, SUITE
108, BATON ROUGE - 70806
(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
Page 51 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
130, BATON ROUGE - 70806
(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
Page 52 of 233
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 - Both2
CommunityCARE Provider Count by Parish
BATON ROUGE SEFA AKWASI PHY INTERNAL MEDICINE S 1 0 856 1000 LIMITED PANEL; AGES 14
- 644560 NORTH BOULEVARD, SUITE
101, BATON ROUGE - 70806
(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,
SUITE 125, BATON ROUGE -
70816(225)926-7200
1943118-003
BARAI, LALIT, MD - 1321648
GUARISCO, MICHAEL, MD - 1381993
GUPTA, ALOK, MD - 1977781
PINO, LANNIE, NP - 1460508
BATON ROUGE STANOCOLA MEDICAL CENTER /
PEDIATRICS DEPT (site 001)
PHY PEDIATRICS K 2 1 1663 2500 AGES 0 - 2016777 MEDICAL CENTER DRIVE,
SUITE 400, BATON ROUGE -
70816(225)926-7200
1943118-001
GIRGIS, SALWA, MD - 1361291
LEMELLE, TRACY, MD - 1044041
PINO, LANNIE, NP - 1460508
BATON ROUGE STANOCOLA MEDICAL CENTER /
PRIMARY CARE DEPT (site 002)
PHY FAMILY PRACTICE 4 1 220 225 LIMITED PANEL; AGES 21
- 6416777 MEDICAL CENTER DRIVE,
SUITE 400, BATON ROUGE -
70816(225)926-7200
1943118-002
GIRGIS, SALWA, MD - 1361291
GUARISCO, MICHAEL, MD - 1381993
MORENO, MARIO, MD - 1330752
PINO, LANNIE, NP - 1460508
STRYJEWSKA, BARBARA, MD - 1660795
Page 53 of 233
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 - Both2
CommunityCARE Provider Count by Parish
BATON ROUGE THOMAS VERONICA PHY PEDIATRICS K 1 0 1144 1144 NEWBORNS AGES 0 - 3M;
CURR PTS& SIBLINGS 4M
- 15Y
8786 GOODWOOD BOULEVARD,
SUITE 107, BATON ROUGE -
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;
CURRENT PTS AGES 11 -
20
4727 WEST PARK DRIVE, SUITE
B, ZACHARY - 70791
(225)654-6140
1941913-026
TALBOT, AMANDA, MD - 1170771
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
Page 54 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
HUNT, GINGER, NP - 1653047
Page 55 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
BLACKMON, BETTIE, NP - 1114367
GILLIAM, DARIE, NP - 1534935
HORNBOSTEL - BAKER, JUDY, NP - 1455016
HUNT, GINGER, NP - 1653047
RANDALL, ZELMA, NP - 1995827
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
Page 56 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
BLACKMON, BETTIE, NP - 1114367
CONNELL, KRISTA, NP - 1409723
GILLIAM, DARIE, NP - 1534935
HORNBOSTEL - BAKER, JUDY, NP - 1455016
HUNT, GINGER, NP - 1653047
RANDALL, ZELMA, NP - 1995827
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
BLACKMON, BETTIE, NP - 1114367
CONNELL, KRISTA, NP - 1409723
GILLIAM, DARIE, NP - 1534935
HORNBOSTEL - BAKER, JUDY, NP - 1455016
HUNT, GINGER, NP - 1653047
RANDALL, ZELMA, NP - 1995827
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
COUNTS, MELODY, MD - 1568961
IBERVILLE
Page 57 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
Page 58 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
KHANOLKAR, ROHIT, MD - 1469238
REDDY, NAGARATNA, MD - 1320251
STAFFORD, TERESA, PA - 1626597
Page 59 of 233
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 - Both2
CommunityCARE Provider Count by Parish
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
KHANOLKAR, ROHIT, MD - 1469238
REDDY, NAGARATNA, MD - 1320251
STAFFORD, TERESA, PA - 1626597
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
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 - Both2
CommunityCARE Provider Count by Parish
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
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 - Both2
CommunityCARE Provider Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
KHANOLKAR, ROHIT, MD - 1469238
REDDY, NAGARATNA, MD - 1320251
STAFFORD, TERESA, PA - 1626597
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
KHANOLKAR, ROHIT, MD - 1469238
STAFFORD, TERESA, PA - 1626597
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
GANDHI, MOHAN, MD - 1334731
HADI, MOHAMMED, MD - 1106267
HARTMAN, MARY, NP - 1551261
JOSEPH, KEVIN, MD - 1486965
LEDET, CHRIS, NP - 1509108
MARDIA, SUDHA, MD - 1576018
SAGDEPHOUR, BAHRAM, MD - 1385671
THOMAS, SOPHIA, NP - 1535516
Page 71 of 233
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
PRACTICE CORP (site 010)
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
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 - Both3
CommunityCARE Provider Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both4
CommunityCARE Provider Count by Parish
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
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 - Both4
CommunityCARE Provider Count by Parish
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
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 - Both4
CommunityCARE Provider Count by Parish
CROWLEY KRISHEN SWEETIE PHY PEDIATRICS K 1 0 1442 2500 AGES 0 - 18; ACCEPTING
NEW PTS AGES 0 - 14
ONLY
1307 CROWLEY - RAYNE
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
1307 CROWLEY - RAYNE
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
K 4 0 1332 1332 CURRENT PATIENTS
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
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 - Both4
CommunityCARE Provider Count by Parish
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;
CURRENT PTS AGES 21 -
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
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 - Both4
CommunityCARE Provider Count by Parish
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,
VILLE PLATTE - 70586
(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,
VILLE PLATTE - 70586
(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,
VILLE PLATTE - 70586
(337)363-6480
1135054-001
Page 90 of 233
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 - Both4
CommunityCARE Provider Count by Parish
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,
JEANERETTE - 70544
(337)276-6018
1365831-001
JEANERETTE JEANERETTE RURAL HEALTH CLINIC RHC RURAL HEALTH
CLINIC
K 0 1 549 1000 AGES 0 - 64217 BOURG STREET,
JEANERETTE - 70544
(337)276-7002
1944637-001
CHAMBERS, HENRIETTA, NP - 1471101
JEANERETTE ONG EDISON PHY INTERNAL MEDICINE S 1 0 405 2500 AGES 0 - 64303 BAYSIDE DRIVE,
JEANERETTE - 70544
(337)276-5408
1530301-001
Page 91 of 233
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 - Both4
CommunityCARE Provider Count by Parish
LOREAUVILLE JAMES RUSSELL ROMERO, MD, RURAL
HEALTH CLINIC
RHC RURAL HEALTH
CLINIC
S 1 0 504 1200 LIMITED PANEL; AGES 2 -
64411 SOUTH MAIN STREET,
LOREAUVILLE - 70552
(337)229-4214
1948390-001
ROMERO, JAMES, MD - 1026816
NEW IBERIA AHMAD MOUNAF PHY PEDIATRICS K 1 0 919 2500 AGES 0 - 20408 NORTH LEWIS, SUITE 100-C,
NEW IBERIA - 70563
(337)365-0268
1996629-001
NEW IBERIA BOUDREAUX STEPHEN PHY GENERAL PRACTICE S 1 0 76 76 CURRENT PATIENTS
AGES 0 - 64520 NORTH LEWIS STEET, SUITE
100, NEW IBERIA - 70563
(337)364-3444
1906336-001
NEW IBERIA CHILDREN'S CENTER, THE (site 002) PHY PEDIATRICS S 5 0 2010 5000 AGES 0 - 182315 EAST MAIN STREET, NEW
IBERIA - 70560
(337)374-7589
1444022-002
DEGRAVELLE, MARTIN, MD - 1147303
GOLAN, TOMAS, MD - 1535397
GOLAN, YASEMIN, MD - 1105848
LAURENTE, SARAH, MD - 1430960
SCOTT, III, WALTER, MD - 1330868
NEW IBERIA CHILDREN'S PRACTICE, THE (site 001) PHY PEDIATRICS K 5 0 3675 5000 AGES 0 - 182308 EAST MAIN STREET, NEW
IBERIA - 70560
(337)560-5005
1444022-001
DEGRAVELLE, MARTIN, MD - 1147303
GOLAN, TOMAS, MD - 1535397
GOLAN, YASEMIN, MD - 1105848
LAURENTE, SARAH, MD - 1430960
SCOTT, III, WALTER, MD - 1330868
Page 92 of 233
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 - Both4
CommunityCARE Provider Count by Parish
NEW IBERIA CLARKE ANDREW PHY INTERNAL MEDICINE 1 0 27 27 CURRENT PATIENTS
AGES 21 - 64520 NORTH LEWIS STREET,
SUITE 203, NEW IBERIA - 70563
(337)364-4738
1483591-001
NEW IBERIA COUSIN GEORGE PHY FAMILY PRACTICE S 1 0 52 52 CURRENT PATIENTS
AGES 0 - 642309 EAST MAIN STREET, SUITE
400, NEW IBERIA - 70563
(337)367-0271
1339814-001
NEW IBERIA DAUTERIVE PHYSICIANS LLC PHY FAMILY PRACTICE /
GENERAL PRACTICE
3 0 13 7500 AGES 21 - 64520 NORTH LEWIS STREET,
SUITE 101, NEW IBERIA - 70563
(337)369-6669
1321583-002
BOUDREAUX, STEPHEN, MD - 1906336
LANDRY, JASON, MD - 1238376
PILLETTE, CASSANDRA, MD - 1076821
NEW IBERIA FAUGOT MAURICE PHY PEDIATRICS K 1 0 282 400 LIMITED PANEL;
CURRENT PTS &
NEWBORNS AGES 0 - 20
1100 ANDRE STREET, SUITE 303,
NEW IBERIA - 70563
(337)365-5437
1304336-001
NEW IBERIA GARCIA JESUS PHY FAMILY PRACTICE S 1 0 30 30 CURRENT PATIENTS
AGES 0 - 641100 ANDRE STREET, SUITE 203,
NEW IBERIA - 70563
(337)367-6776
1966479-001
NEW IBERIA IBERIA COMPREHENSIVE COMMUNITY
HEALTH CENTER
FQHC FEDERALLY
QUALIFIED HEALTH
CENTER
K 4 1 1716 10500 AGES 0 - 64806 JEFFERSON TERRACE
BOULEVARD, NEW IBERIA - 70560
(337)365-4945
1940984-001
COLLINS, JASON, NP - 1459666
JACKSON, VICTOR, MD - 1172499
RAMSEY, KEITH, MD - 1541109
WHITNEY, KENYA, MD - 1071048
WOODARD, THERESA, MD - 1050636
Page 93 of 233
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 - Both4
CommunityCARE Provider Count by Parish
NEW IBERIA LAHASKY ROBERT PHY FAMILY PRACTICE S 1 0 68 68 CURRENT PATIENTS
AGES 0 - 64520 NORTH LEWIS, SUITE 203,
NEW IBERIA - 70563
(337)364-4738
1346632-001
NEW IBERIA LANGLINAIS ANGELA PHY FAMILY PRACTICE S 1 0 77 77 CLOSED PANEL2309 EAST MAIN STREET, SUITE
201, NEW IBERIA - 70560
(337)560-8400
1491683-001
NEW IBERIA MATA JOSE PHY FAMILY PRACTICE S 1 0 36 36 CURRENT PATIENTS
AGES 0 - 642309 EAST MAIN STREET, SUITE
400, NEW IBERIA - 70563
(337)367-0271
1333093-001
NEW IBERIA MULLEN ELLEN PHY FAMILY PRACTICE K 1 0 65 65 CLOSED PANEL2312 EAST MAIN STREET, SUITE
B, NEW IBERIA - 70560
(337)364-0938
1466352-001
NEW IBERIA NUGENT JANICE PHY GENERAL PRACTICE K 1 0 143 150 LIMITED PANEL; AGES 0 -
64520 NORTH LEWIS STREET,
SUITE 204, NEW IBERIA - 70563
(337)365-6251
1492388-001
NEW IBERIA ODOM LEANDRE PHY FAMILY PRACTICE K 1 0 488 500 LIMITED PANEL; AGES 2 -
642313 EAST MAIN STREET, NEW
IBERIA - 70560
(337)560-5323
1576271-001
NEW IBERIA PALMIANO ALBERT PHY FAMILY PRACTICE K 1 0 144 144 CLOSED PANEL2312 EAST MAIN STREET, SUITE
B, NEW IBERIA - 70560
(337)364-0938
1967084-001
Page 94 of 233
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 - Both4
CommunityCARE Provider Count by Parish
NEW IBERIA PEDIATRIC GROUP OF ACADIANA, LLC PHY PEDIATRICS K 7 1 6292 10000 AGES 0 - 20; ACCEPTING
NEW PTS AGES 0 - 18
ONLY
520 NORTH LEWIS, SUITE 202,
NEW IBERIA - 70563
(337)367-2001
1440604-001
ABOU - TURK, CHIRINE, MD - 1456578
ARUNACHALAM, ANNAPOORANI, MD - 1133159
ATWI, JIBRAN, MD - 1988791
BROWN, JILL, MD - 1389781
EIKEL, HENRY, MD - 1984345
GOLAN, YASEMIN, MD - 1105848
RADER, ALISON, MD - 1047708
VICE, COURTNEY, PA - 1407208
NEW IBERIA RADER ALLISON PHY PEDIATRICS K 1 0 353 2500 AGES 0 - 20408 NORTH LEWIS STREET,
SUITE 100 - C, NEW IBERIA -
70560(337)365-0268
1047708-001
NEW IBERIA RAYMOND F. SCHNEIDER MEMORIAL
CLINIC
RHC RURAL HEALTH
CLINIC
K 2 1 116 1000 AGES 0 - 641302 ED BROUSSARD ROAD,
NEW IBERIA - 70563
(337)229-7929
1037591-001
COUSIN, GEORGE, MD - 1339814
MULLEN, ELLEN SHEA, MD - 1466352
SCHNEIDER, NANCY, NP - 1994511
NEW IBERIA SAGRERA GEORGE PHY GENERAL PRACTICE S 1 0 75 75 CURRENT PATIENTS
AGES 0 - 64602 WEST ST PETER STREET,
NEW IBERIA - 70560
(337)364-8196
1062138-001
LAFAYETTE
CARENCRO KENNEDY MICHAEL PHY FAMILY PRACTICE S 1 0 629 629 CURRENT PATIENTS &
SIBLINGS AGES 0 - 64111 ST. CHARLES STREET,
CARENCRO - 70520
(337)886-1200
1377104-001
Page 95 of 233
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 - Both4
CommunityCARE Provider Count by Parish
CARENCRO NGUYEN NHU - VONG PHY FAMILY PRACTICE S 1 0 1176 2500 AGES 6 MTHS - 64 YRS208 NORTH CHURCH STREET,
CARENCRO - 70520-3623
(337)896-4090
1342017-001
DUSON DUSON FAMILY HEALTHCARE NP FAMILY PRACTICE K 0 1 201 1000 AGES 0 - 649023 CAMERON STREET, DUSON
- 70529
(337)873-8244
1592919-001
ROY, TIFFANY, NP - 1592919
LAFAYETTE AHS WALK IN CLINIC PHY FAMILY PRACTICE K 2 0 19 2500 AGES 2 - 641602 WEST PINHOOK ROAD,
SUITE 100, LAFAYETTE - 70508
(337)234-9925
1317179-001
RIEHL, WINSTON, MD - 1053449
THIBODEAUX, JR, VERNE, MD - 1087670
LAFAYETTE BARES GEORGE PHY PEDIATRICS S 1 0 383 383 CURRENT PATIENTS
AGES 0 - 204650 AMBASSADOR CAFFERY, #
206, LAFAYETTE - 70508
(337)988-2345
1662917-001
LAFAYETTE BRUNO CARLOS PHY PEDIATRICS K 1 0 741 741 CURRENT, SIBLINGS &
NEWBORNS SEEN @
HOSP AGES 0-20
811 ALBERTSONS PARKWAY,
SUITE A, LAFAYETTE - 70508
(337)839-2265
1498882-001
LAFAYETTE CHRISTY LAWRENCE PHY PEDIATRICS K 1 0 2241 2500 AGES 0 - 18600 EAST THIRD STREET,
LAFAYETTE - 70501
(337)232-8814
1312959-001
Page 96 of 233
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 - Both4
CommunityCARE Provider Count by Parish
LAFAYETTE GRANGER BRIAN PHY FAMILY PRACTICE S 1 0 19 19 CLOSED PANEL201 WEST GLORIA SWITCH
ROAD, SUITE I, LAFAYETTE -
70507(337)565-6012
1491314-001
LAFAYETTE HAMILTON MEDICAL GROUP - FAMILY
PRACTICE (site 001)
PHY FAMILY PRACTICE S 3 0 10 10 CLOSED PANEL4212 WEST CONGRESS,
LAFAYETTE - 70506
(337)988-8810
1113328-001
MANUEL, FRANCINE, MD - 1357871
MATIS, RICK, MD - 1194271
SALMERON, DANIEL, MD - 1071064
LAFAYETTE HAMILTON MEDICAL GROUP - FAMILY
PRACTICE NORTH (site 003)
PHY FAMILY PRACTICE S 1 0 28 28 CLOSED PANEL3414 MOSS STREET, LAFAYETTE
- 70507
(337)232-0038
1113328-003
LANDRY, NATHAN, MD - 1377376
LAFAYETTE HAMILTON MEDICAL GROUP -
PEDIATRICS (site 002)
PHY PEDIATRICS S 1 0 88 88 CLOSED PANEL4540 AMBASSADOR CAFFERY
PARKWAY, SUITE B 220,
LAFAYETTE - 70503(337)984-2444
1113328-002
BAUMBOUREE, DEREK, MD - 1493708
LAFAYETTE JAMES MWATIBO & JOHNNY
STEPHENS, LLC (site 001)
PHY FAMILY PRACTICE /
INTERNAL MEDICINE
S 2 0 304 304 CLOSED PANEL850 NORTH PIERCE STREET,
SUITE D, LAFAYETTE - 70501
(337)233-2115
1443522-001
MWATIBO, JAMES, MD - 1576212
STEPHENS, JOHNNY, MD - 1576697
LAFAYETTE JOLIVETTE MILTON PHY INTERNAL MEDICINE 1 0 18 18 CURRENT PATIENTS
AGES 21 - 64501 WEST ST. MARY
BOULEVARD, SUITE 300,
LAFAYETTE - 70506(337)234-1945
1195367-001
Page 97 of 233
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 - Both4
CommunityCARE Provider Count by Parish
LAFAYETTE LAFAYETTE CHILDRENS CLINIC, LLC PHY PEDIATRICS S 3 0 152 152 CURRENT PATIENTS
AGES 0 - 185000 AMBASSADOR CAFFERY
PARKWAY, #12, LAFAYETTE -
70508(337)989-5061
1025437-001
BAILEY, BRIAN, MD - 1462501
COREIL, VIRGINIA, MD - 1540382
RABALAIS, MICHAEL, MD - 1553816
LAFAYETTE LEBEAN BRYAN PHY INTERNAL MEDICINE 1 0 40 40 CURRENT PATIENTS
AGES 21 - 642930 MOSS STREET, SUITE B,
LAFAYETTE - 70501
(337)261-0559
1656542-001
LAFAYETTE LEBRON ALFREDO PHY PEDIATRICS K 1 0 1369 1369 CURRENT PATIENTS AND
NEWBORNS AGES 0 - 184540 AMBASSADOR CAFFERY,
SUITE B130, LAFAYETTE - 70508
(337)981-8486
1971731-001
LAFAYETTE LOUIS CHARLES PHY INTERNAL MEDICINE S 1 0 66 66 CURRENT PATIENTS
AGES 12 - 643911 MOSS STREET, LAFAYETTE
- 70501
(337)262-0091
1939994-001
LAFAYETTE LSUHN-UMC FAMILY PRACTICE (site
002)
PHY FAMILY PRACTICE S 6 0 1781 20000 AGES 0 - 642390 WEST CONGRESS STREET,
LAFAYETTE - 70506
(337)261-6655
1038270-002
BROUSSARD, ALAN, MD - 1674133
HUMBLE, KENT, MD - 1991571
MIRE, GLEN, MD - 1197386
OGE', LINDA, MD - 1973564
REES, ALBERT, MD - 1107735
ROSSON, KATHLEEN, MD - 1904732
Page 98 of 233
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 - Both4
CommunityCARE Provider Count by Parish
LAFAYETTE LSUHN-UMC MEDICINE (site 003) PHY INTERNAL MEDICINE S 9 0 913 10000 AGES 18 - 642390 WEST CONGRESS STREET,
LAFAYETTE - 70506-4205
(337)261-6100
1038270-003
BENOIT - CLARK, TINA, MD - 1933899
CURRY, KAREN, MD - 1672289
GUIDRY, LONN, MD - 1355704
HUBBELL, GERALD, MD - 1113841
JAIKISHEN, JAY, MD - 1039053
LAKSHMIPRASAD, LEELA, MD - 1345733
LAMARCHE, MAXIMO, MD - 1193216
LOUIS, CHARLES, MD - 1939994
SAENZ, ROLANDO, MD - 1032806
LAFAYETTE LSUHN-UMC PEDIATRICS (site 001) PHY PEDIATRICS S 10 0 2971 15000 AGES 0 - 182390 WEST CONGRESS STREET,
LAFAYETTE - 70506
(337)261-6565
1038270-001
BARNES, STEPHEN, MD - 1367419
DAHR, NAHLA, MD - 1539601
DALAL, GEETA, MD - 1365637
FOX, DONNA, MD - 1902438
HOWES, RICHARD, MD - 1160466
KRETSCHMER, THEODORE, MD - 1025844
NERVEZ, CECILIA, MD - 1169404
SHARMA, SARITA, MD - 1377678
THOMAS, MARY, MD - 1334910
WILSON, DONNA, MD - 1378542
LAFAYETTE MANUEL MEDICAL CLINIC PHY PEDIATRICS K 1 0 1654 2500 AGES 0 - 20104 GENEVIEVE DRIVE,
LAFAYETTE - 70503
(337)984-0110
1940623-002
MANUAL, POWLIN, MD - 1171689
LAFAYETTE MELANCON MICHAEL PHY PEDIATRICS S 1 0 323 323 CURRENT PATIENTS &
NEWBORNS AGES 0 - 174650 AMBASSADOR CAFFERY
PARKWAY, SUITE 105,
LAFAYETTE - 70508(337)989-8080
1324833-001
Page 99 of 233
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 - Both4
CommunityCARE Provider Count by Parish
LAFAYETTE MICHAEL K. JUDICE, MD, LTD, APMC PHY PEDIATRICS K 4 0 208 208 CURRENT PATIENTS
AGES 0 - 174630 AMBASSADOR CAFFERY
PARKWAY, SUITE 102,
LAFAYETTE - 70508(337)989-2322
1940437-001
BOUSTANY, JENNIFER, MD - 1378593
CROWE, DEBRA, MD - 1993638
HUVAL, FARRAH, MD - 1059994
JUDICE, MICHAEL, MD - 1341053
LAFAYETTE MOORE PATRICK PHY FAMILY PRACTICE S 1 0 34 2500 AGES 0 - 643400 MOSS STREET, LAFAYETTE
- 70507
(337)706-8986
1572659-001
LAFAYETTE MOSS STREET KIDMED PHY GENERAL PRACTICE K 1 1 2794 3000 AGES 0 - 641417 MOSS STREET, SUITE A,
LAFAYETTE - 70501
(337)291-2411
1949221-001
DUGAL, CHARLES, MD - 1148237
JOHNSON, RICKIE, PA - 1627755
LAFAYETTE PEDIATRIC ASSOCIATES OF
LAFAYETTE
PHY PEDIATRICS S 5 0 10 10 CLOSED PANEL437 HEYMANN BOULEVARD,
LAFAYETTE - 70503
(337)289-8989
1440795-001
GONZALES, JR., DOUGLAS, MD - 1995096
HEBERT, MELISSA, MD - 1074900
LEONI, TONI, MD - 1484865
LIM, SUSANA, MD - 1998524
MELANCON, ELIZABETH, MD - 1678724
LAFAYETTE PEDIATRIC GROUP OF ACADIANA, LLC PHY PEDIATRICS K 5 0 3914 5000 AGES 0 - 18410 YOUNGSVILLE HIGHWAY,
SUITE 100, LAFAYETTE - 70508
(337)330-0031
1440604-002
ATWI, JIBRAN, MD - 1988791
FILHO, FERMIN, MD - 1373796
OBENZA, MARITA, MD - 1168203
PAPP, LASZLO, MD - 1583791
SAYED, MYRIAM, MD - 1564915
Page 100 of 233
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 - Both4
CommunityCARE Provider Count by Parish
LAFAYETTE ROBINSON DARRELL PHY OBGYN S 1 0 641 1000 LIMITED PANEL;
FEMALES ONLY, AGES 12
- 64
4630 AMBASSADOR CAFFREY,
SUITE 214, LAFAYETTE - 70508
(337)981-6969
1661848-001
LAFAYETTE SIBLEY BRYAN PHY PEDIATRICS K 1 0 2187 2500 AGES 0 - 14; ACCEPTS
NEW PATIENTS AGES 0 -
10 ONLY
1211 COOLIDGE BOULEVARD,
SUITE 300, LAFAYETTE - 70503
(337)289-0042
1962848-001
LAFAYETTE SMITH KAREN PHY INTERNAL MEDICINE 1 0 5 5 CURRENT PATIENTS
AGES 21 - 64601 WEST ST. MARY
BOULEVARD, SUITE 403,
LAFAYETTE - 70506(337)233-3731
1565342-001
LAFAYETTE WILLIAMS, SR. GERARD PHY PEDIATRICS /
INTERNAL MEDICINE
K 1 0 1028 1028 OPEN AGES BIRTH - 2 M;
CURRENT PTS AGES 3M -
64YRS
901 WEST GLORIA SWITCH
ROAD, LAFAYETTE - 70507
(337)886-0023
1431486-001
LAFAYETTE YOUNG CLINTON PHY INTERNAL MEDICINE S 1 0 98 98 CURRENT PATIENTS
AGES 12 - 64850 NORTH PIERCE STREET,
SUITE B, LAFAYETTE - 70501
(337)237-6712
1181625-001
SCOTT ACADIA WALK - IN CLINIC
CORPORATION
PHY PEDIATRICS K 2 0 1658 5000 AGES 0 - 206100 CAMERON STREET, SCOTT -
70583
(337)289-6770
1441457-002
FREIJI, RUAL, MD - 1683485
MOUAWAD, DANI, MD - 1533131
Page 101 of 233
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 - Both4
CommunityCARE Provider Count by Parish
SCOTT SCOTT FAMILY CLINIC PHY FAMILY PRACTICE K 0 2 986 1000 AGES 0 - 645935 CAMERON STREET, SCOTT -
70583
(337)264-0326
1444936-001
MALONE, IRIS, NP - 1127582
MIEDECKE, SUSAN, NP - 1102652
YOUNGSVILLE LAURENTE SARAH PHY PEDIATRICS K 1 0 723 800 LIMITED PANEL; AGES 0 -
18814 FORTUNE ROAD, SUITE 108,
YOUNGSVILLE - 70592
(337)857-5096
1430960-001
ST. LANDRY
CANKTON FLEUR - DE - LIS COMMUNITY HEALTH RHC RURAL HEALTH
CLINIC
K 0 2 395 2000 AGES 0 - 64376 MAIN STREET, CANKTON -
70584
(337)668-4141
1447919-001
GUILLORY, GEORGETTE, NP - 1634743
NEELY, ANGELA, NP - 1634760
EUNICE BEAUCHAMP - ROCHE KERMAN PHY PEDIATRICS K 1 0 1072 2500 AGES 0 - 173521 HIGHWAY 190, SUITE R,
EUNICE - 70535
(337)457-2301
1976440-001
EUNICE FITZGERALD STEPHEN PHY INTERNAL MEDICINE 1 0 89 2500 AGES 21 - 64151 HILL STREET, SUITE 2,
EUNICE - 70535
(337)457-4415
1690457-001
Page 102 of 233
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 - Both4
CommunityCARE Provider Count by Parish
EUNICE HEBERT MEDICAL GROUP PHY PEDIATRICS K 5 0 684 12500 AGES 0 - 18; ACCEPTS
NEWBORNS AGES 0 - 2
MNTH ONLY
3521 HIGHWAY 190, SUITE S,
EUNICE - 70535
(337)550-8530
1444537-001
BARNES, DONALD, MD - 1158445
BUTLER, ALLEN, MD - 1151262
BUTLER, HEATHER, MD - 1150274
HEBERT, CHARICE, MD - 1483753
HEBERT, RICHARD, MD - 1569615
EUNICE HEINEN OBSTETRTICS &
GYNECOLOGY
PHY OBGYN 1 1 96 100 LIMITED PANEL; FEMALE
ONLY AGES 21 - 453448 HIGHWAY 190, EUNICE -
70535
(337)546-6237
1445312-001
ACREE, KATHLEEN, CNM - 1697974
HEINEN, MONTY, MD - 1494551
EUNICE PULLIN TODD PHY PEDIATRICS K 1 0 1391 1391 OPEN AGES 0 - 6;
CURRENT PTS &
SIBLINGS AGES 7 -20
3521 HIGHWAY 190 EAST, SUITE
N, EUNICE - 70535
(337)550-1175
1183709-001
EUNICE ROBINSON JULIET PHY INTERNAL MEDICINE S 1 0 107 107 CURRENT PATIENTS
AGES 10 - 643521 HIGHWAY 190, SUITE V,
EUNICE - 70535
(337)550-0405
1497738-001
EUNICE SAVOY FAMILY CARE RHC RURAL HEALTH
CLINIC
K 2 2 1570 5500 AGES 0 - 64102 SOUTH 2ND STREET, EUNICE
- 70535
(337)457-3135
1947911-001
FRAZER, CHARLES, MD - 1068764
LANDRY, KRISTINA, NP - 1342416
MICHAEL, NICOLE, MD - 1973041
SONNIER, MICHAEL, NP - 1464589
Page 103 of 233
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 - Both4
CommunityCARE Provider Count by Parish
EUNICE STEARNS ZEBEDIAH PHY FAMILY PRACTICE K 1 0 116 116 CLOSED PANEL450 MOOSA BOULEVARD, SUITE
A, EUNICE - 70535
(337)546-6646
1576689-001
EUNICE WARE DAVID PHY FAMILY PRACTICE K 1 0 77 77 CLOSED PANEL3521 HIGHWAY 190, SUITE P,
EUNICE - 70535
(337)457-8040
1123153-001
OPELOUSAS ALAM USMAN PHY INTERNAL MEDICINE S 1 0 75 75 CLOSED PANEL611 EAST PRUDHOMME STREET,
SUITE 3, OPELOUSAS - 70570
(337)942-5750
1549037-001
OPELOUSAS ALL KIDS PEDIATRIC OF OPELOUSAS PHY PEDIATRICS K 1 0 2640 2500 MAX CAP EXCEEDED;
ACCEPTS AGES
0-2M;CURR PTS 3M-18
920 NORTH MAIN STREET,
OPELOUSAS - 70570
(337)407-8697
1449482-001
SINGLETON - BEN, MIA, MD - 1493058
OPELOUSAS BERTRAND CHARLES PHY PEDIATRICS K 1 0 1304 2500 AGES 0 - 20611 PRUDHOMME STREET, SUITE
5, OPELOUSAS - 70570
(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
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 - Both4
CommunityCARE Provider Count by Parish
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
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 - Both4
CommunityCARE Provider Count by Parish
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
ELLIOTT, JR, LEONE, MD - 1568970
Page 106 of 233
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 - Both4
CommunityCARE Provider Count by Parish
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
414 NORTH MAIN STREET,
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
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 - Both4
CommunityCARE Provider Count by Parish
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
ATWI, JIBRAN, MD - 1988791
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
ATWI, JIBRAN, MD - 1988791
BROWN, JIL, MD - 1389781
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
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 - Both4
CommunityCARE Provider Count by Parish
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
ATWI, JIBRAN, MD - 1988791
BROWN, JIL, MD - 1389781
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
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 - Both4
CommunityCARE Provider Count by Parish
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
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 - Both4
CommunityCARE Provider Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both5
CommunityCARE Provider Count by Parish
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
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 - Both5
CommunityCARE Provider Count by Parish
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
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 - Both5
CommunityCARE Provider Count by Parish
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
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 - Both5
CommunityCARE Provider Count by Parish
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
600, LAKE CHARLES - 70601
(337)491-7072
1016284-001
Page 120 of 233
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 - Both5
CommunityCARE Provider Count by Parish
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
PHY PEDIATRICS K 11 2 9037 9037 CURRENT PATIENTS
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
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 - Both5
CommunityCARE Provider Count by Parish
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,
LAKE CHARLES - 70601
(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,
LAKE CHARLES - 70601
(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
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 - Both5
CommunityCARE Provider Count by Parish
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
8, LAKE CHARLES - 70611
(337)312-0030
1199711-001
Page 123 of 233
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 - Both5
CommunityCARE Provider Count by Parish
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,
NEWBORNS, & SIBLINGS
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;
CURRENT PTS AGES 17 -
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
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 - Both5
CommunityCARE Provider Count by Parish
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
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 - Both5
CommunityCARE Provider Count by Parish
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
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 - Both5
CommunityCARE Provider Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
GAUTHIER, JR, NEWELL, MD - 1127035
JEANSONNE, II, HERNDON, NP - 1306371
NEWMAN, TAMATHA, NP - 1469637
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
ELLIOTT, JR, LEONE, MD - 1568970
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
GAUTHIER, JR, NEWELL, MD - 1127035
GAUTHIER, JR, NEWELL, MD - 1127035
JEANSONNE, HERNDON, NP - 1306371
NEWMAN, TAMATHA, NP - 1469637
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
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 - Both6
CommunityCARE Provider Count by Parish
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
ARNOLD, HUGH, NP - 1560171
IQBAL, ATHER, MD - 1529435
PORTER, MARY, NP - 1469785
TRUNZLER, BASIL, MD - 1104221
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
ALEXANDRIA LSUMC - S FAMILY PRACTICE
MEDICINE
PHY FAMILY PRACTICE K 17 0 1632 1632 OPEN AGES 0 - 18;
CURRENT PTS AGES 19 -
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
PAUL, RHONDA, NP - 1453323
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
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 - Both6
CommunityCARE Provider Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both7
CommunityCARE Provider Count by Parish
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
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 - Both7
CommunityCARE Provider Count by Parish
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
KNIGHTON MEDICAL CENTER
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
Page 154 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
HENDERSON, GEORGE, MD - 1190519
MILLER, MARY, NP - 1464597
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
201, SHREVEPORT - 71101
(318)848-2810
1493791-001
Page 155 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
Page 156 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
BASS, III, PAT, MD - 1493686
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
Page 157 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
Page 158 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
BASS, III, PAT, MD - 1493686
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
Page 159 of 233
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 - Both7
CommunityCARE Provider Count by Parish
SHREVEPORT PEDIATRIC ASSOCIATES OF
SHREVEPORT, LLC
PHY PEDIATRICS K 4 0 1038 1038 CURRENT PATIENTS
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
400, SHREVEPORT - 71101
(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
PHY FAMILY PRACTICE /
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
104, SHREVEPORT - 71106
(318)869-2181
1535915-001
Page 160 of 233
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 - Both7
CommunityCARE Provider Count by Parish
SHREVEPORT WEBB ETHAN PHY INTERNAL MEDICINE 1 0 7 7 CLOSED PANEL1801 FAIRFIELD AVENUE, SUITE
210, SHREVEPORT - 71101
(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
Page 161 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
HENDERSON, GEORGE, MD - 1190519
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
Page 162 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
Page 163 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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,
NATCHITOCHES - 71457
(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,
NATCHITOCHES - 71457
(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,
NATCHITOCHES - 71457
(318)356-7211
1949574-001
ADELEYE, OLUSEGUN, MD - 1582018
OSHIKANLU, OLABISI, MD - 1996971
Page 164 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
KNIGHTON MEDICAL CENTER
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
Page 165 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
Page 166 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
MILLER, MARY, NP - 1464597
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
Page 167 of 233
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 - Both7
CommunityCARE Provider Count by Parish
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
382 NORTH MAIN STREET,
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
Page 168 of 233
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
ARNOLD, HUGH, NP - 1560171
GRAY, CYNTHIA, NP - 1378127
PORTER, MARY, NP - 1469785
SMITH, ROGER, MD - 1386839
TRUNZLER, BASIL, MD - 1104221
Page 177 of 233
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
RUSTON GREEN CLINIC, LLC (site 002) PHY INTERNAL MEDICINE 2 0 14 14 CLOSED PANEL1200 SOUTH FARMERVILLE
STREET, RUSTON - 71270
(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
STREET, RUSTON - 71270
(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
STREET, RUSTON - 71270
(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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
CARTER, SANDRA, NP - 1141721
CLARK, REBECCA, NP - 1362484
CROCKETT, ALECIA, NP - 1143235
DAVIS, MARYANNE, MD - 1439916
MORGAN, BELINDA, NP - 1544060
POLIQUIT, RAYMOND, MD - 1989215
POPE, SHELIA, NP - 1529265
WASHINGTON, ADRIAN, NP - 1024368
Page 185 of 233
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 - Both8
CommunityCARE Provider Count by Parish
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
CARTER, SANDRA, NP - 1141721
CLARK, REBECCA, NP - 1362484
CROCKETT, ALECIA, NP - 1143235
DAVIS, MARYANNE, NP - 1439916
MORGAN, BELINDA, NP - 1544060
POLIQUIT, RAYMOND, MD - 1989215
POPE, SHELIA, NP - 1529265
WASHINGTON, ADRIAN, NP - 1024368
MONROE PROGRESSIVE PEDIATRICS PHY PEDIATRICS S 2 0 208 240 LIMITED PANEL;
CURRENT PTS AGES 0 -
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
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 - Both8
CommunityCARE Provider Count by Parish
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
PAUL, RHONDA, NP - 1453323
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
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 - Both8
CommunityCARE Provider Count by Parish
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
FLORICE, JOE, NP - 1454346
MILLER, BRENDA, NP - 1437565
MOBERLEY, COURTNEY, NP - 1722227
MORGAN, BELINDA, NP - 1544060
ROBERSON, STEVE, NP - 1025488
WHITE, II, GORDON, MD - 1423688
YELVERTON, EMILIAMA, NP - 1623466
Page 190 of 233
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 - Both8
CommunityCARE Provider Count by Parish
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
FLORICE, JOE, NP - 1454346
MILLER, BRENDA, NP - 1437565
MOBERLEY, COURTNEY, NP - 1722227
MORGAN, BELINDA, NP - 1544060
ROBERSON, STEVE, NP - 1025488
WHITE, II, GORDON, MD - 1423688
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
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 - Both8
CommunityCARE Provider Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
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 - Both9
CommunityCARE Provider Count by Parish
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
311 VETERANS BOULEVARD,
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
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 - Both9
CommunityCARE Provider Count by Parish
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
230 VETERANS BOULEVARD,
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
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 - Both9
CommunityCARE Provider Count by Parish
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
BLOUNT, LAURA, NP - 1027774
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
BLOUNT, LAURA, NP - 1027774
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
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 - Both9
CommunityCARE Provider Count by Parish
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
PRACTICE CORP (site 003)
PHY PEDIATRICS K 4 0 496 496 CURRENT PATIENTS
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
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 - Both9
CommunityCARE Provider Count by Parish
COVINGTON OCHSNER CLINIC MANDEVILLE PHY PEDIATRICS K 6 0 962 962 AGES 0 - 20; ACCEPTS
CURRENT PTS AGES 0 -
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
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 - Both9
CommunityCARE Provider Count by Parish
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
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 - Both9
CommunityCARE Provider Count by Parish
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
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 - Both9
CommunityCARE Provider Count by Parish
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
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 - Both9
CommunityCARE Provider Count by Parish
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
GANDHI, MOHAN, MD - 1334731
LEDET, CHRIS, NP - 1509108
NACHABE, MOUSTAFA, MD - 1990078
SADEGHPOUR, BAHRAM, MD - 1385671
THOMAS, SOPHIA, NP - 1535516
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
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 - Both9
CommunityCARE Provider Count by Parish
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
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 - Both9
CommunityCARE Provider Count by Parish
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
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 - Both9
CommunityCARE Provider Count by Parish
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)
PHY FAMILY PRACTICE /
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
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 - Both9
CommunityCARE Provider Count by Parish
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,
INDEPENDENCE - 70443
(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,
INDEPENDENCE - 70443
(985)878-0066
1448109-001
DALFERES, PATRICIA, NP - 1141232
DAVIS, MARVETTA, MD - 1697761
KESHELAVA, GEORGE, MD - 1075914
Page 212 of 233
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 - Both9
CommunityCARE Provider Count by Parish
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
COUNTS, MELODY, MD - 1568961
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
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 - Both9
CommunityCARE Provider Count by Parish
BOGALUSA LSU - WASHINGTON ST. TAMMANY
REGIONAL MEDICAL CENTER
PHY MULTI - SPECIALTY
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
BOGALUSA LSU - WASHINGTON ST. TAMMANY
REGIONAL MEDICAL CENTER
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
BOGALUSA LSU - WASHINGTON ST. TAMMANY
REGIONAL MEDICAL CENTER
PHY FAMILY PRACTICE /
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
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 - Both9
CommunityCARE Provider Count by Parish
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
REGIONAL MEDICAL CENTER
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
CommunityCARE Provider and Physician Summary Count by Parish
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
ACS Government Healthcare Solutions
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
ACS Government Healthcare Solutions
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 2
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 2
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 3
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 4
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 5
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 6
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 6
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 7
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 7
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 8
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 8
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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
ACS Government Healthcare Solutions
KIDMED Providers by Parish
Region 9
RESTRICTIONSPROVIDER TYPEPROVIDER NAMECITYPARISH
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