Urban Rehab, Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

URBAN REHAB, INC

Practice address

901 Highway 80 E
Clinton, MS 39056-5244

Phone

(601) 927-0188

Fax

(601) 292-7998

NPI assigned

Jul 22, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Philip Massey, LCSW, CADC IINPI 1306242458

Title

Executive Director

Phone

(601) 927-0188

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

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

• Urban Rehab, Inc

  • Clinical Social Worker
  • Clinton, MS
  • NPI 1417370313

  7012214638

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Urban Rehab, Inc

  • Clinical Social Worker
  • Clinton, MS
  • NPI 1417370313

  O20160328000462

  Same enrollment

Tax ID family

Ur Incorporated2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Urban Rehab, Inc

  • Clinical Social Worker
  • Clinton, MS
  • NPI 1417370313
  NPD tax ID

Networks

• AL HMO D-SNP

Practitioners 2

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

• Philip Massey

  • Clinical Social Worker
  • Jackson, MS
  • NPI 1306242458
  NPD Authorized official
• Billy Ray Walton, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Whitfield, MS
  • NPI 1871980995
  NPD (past)

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1003469743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2305",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390602305",
            "telephone_number": "601-927-0188",
            "fax_number": "601-292-7998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 HIGHWAY 80 E",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565244",
            "telephone_number": "601-927-0188",
            "fax_number": "601-292-7998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN REHAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-22",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "MASSEY",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-927-0188",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW, CADC II"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02551264",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF MENTAL HEALTH",
            "identifier": "URI-AGENCY",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Box",
            "affiliation": "N",
            "endpointDescription": "HIPPA Compliant Electronic Data Portal",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDF",
            "address_1": "901 Highway 80 E",
            "city": "Clinton",
            "state": "MS",
            "country_code": "US",
            "postal_code": "390565244",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://urbanrehabinc.app.box.com/folder/0",
            "affiliation": "N",
            "endpointDescription": "hippa compliant data and records exhange",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDF",
            "address_1": "901 Highway 80 E",
            "city": "Clinton",
            "state": "MS",
            "country_code": "US",
            "postal_code": "390565244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• United Rehab Associates of Clinton, LLC
• Urban Rehab, Inc
• Hayden Van Norman
• Lakesha Varnell
• Jennifer Whatley Vaughn, PT
• Matthew Verret, MS, ATC

• All providers in Clinton, MS
• Mental Health Clinic/Center (Including Community Mental Health Center) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.