NPIMap

Organization Active NPI

Central Mississippi Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
National Provider Identifier
1003470758
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC
Practice address
3450 Highway 80 W Ste 71
Jackson, MS 39209-7201
Phone
(601) 321-2400
NPI assigned
Apr 29, 2019
Organization subpart
Yes
Parent organization
CENTRAL MISSISSIPPI HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Terry Johnson
Title
Human Resource Manager
Phone
(601) 948-5572

Specialties & licenses 1

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

Addresses

Primary practice location

3450 Highway 80 W Ste 71
Jackson, MS 39209-7201

Mailing address

1134 Winter St
Jackson, MS 39204-2841
Phone (601) 948-5572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225000632 MS Part B Supplier - Clinic/Group Practice 2961398029 Receives reassigned benefits from 24 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MS; Tougaloo, MS

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Denzil G Robertson

Locations

3450 Highway 80 W
Ste 71
Jackson, MS 39209
Phone (601) 321-2400

Networks

  • AL HMO D-SNP

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1003470758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 WINTER ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392042841",
            "telephone_number": "601-948-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 HIGHWAY 80 W STE 71",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392097201",
            "telephone_number": "601-321-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL MISSISSIPPI HEALTH SERVICES, INC",
        "enumeration_date": "2019-04-29",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "HUMAN RESOURCE MANAGER",
        "authorized_official_telephone_number": "601-948-5572"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.