JEFFERSON STREET PRIMARY CARE CLINIC
NPI 1124811450
Clinic/Center - Primary Care in Lafayette, LA
About Jefferson Street Primary Care Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JEFFERSON STREET PRIMARY CARE CLINIC (NPI 1124811450) is a healthcare organization registered as a primary care in Lafayette, Louisiana and active in the NPI registry since May 2025. The organization lists Antoinette Rabenaldt, Credentialing Coordinator/hr, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jefferson Street Primary Care Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Jefferson Street Primary Care Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jefferson Street Primary Care Clinic's NPI number?
The NPI number for Jefferson Street Primary Care Clinic is 1124811450. It was assigned to this organization in the NPPES registry on May 28, 2025.
Where is Jefferson Street Primary Care Clinic located?
Jefferson Street Primary Care Clinic is located at 618 Jefferson Blvd, Lafayette, LA 70501. The listed phone number is (337) 345-1709.
What is Jefferson Street Primary Care Clinic's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Jefferson Street Primary Care Clinic enrolled in Medicare?
Yes. Jefferson Street Primary Care Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Jefferson Street Primary Care Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Jefferson Street Primary Care Clinic. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Jefferson Street Primary Care Clinic was last updated on February 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jefferson Street Primary Care Clinic · NPI 1124811450
Primary Care organization in Lafayette, Louisiana. Organization record, active in the CMS NPPES registry since May 28, 2025.
## Identity
- **NPI:** 1124811450 (Entity type: Organization)
- **Enumerated:** May 28, 2025
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Antoinette Rabenaldt, CREDENTIALING COORDINATOR/HR
## Practice location
- **Address:** 618 JEFFERSON BLVD, Lafayette, LA 70501-7206
- **Phone:** (337) 345-1709 · **Fax:** (337) 345-4221
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 11, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1124811450) · Data from the CMS NPPES public registry.