NPIMap

Organization Active NPI

Hattiesburg Public School and Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Hattiesburg, MS
National Provider Identifier
1023087400
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HATTIESBURG PUBLIC SCHOOL AND COMMUNITY CLINIC
Doing business as
Hattiesburg Public School and Community Clinic
Practice address
404 Lillie Burney St
Hattiesburg, MS 39401-5505
Phone
(601) 450-6500
Fax
(601) 450-6503
NPI assigned
Mar 16, 2006
Last updated
Feb 6, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

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

Authorized official

Name
Janice Robinson
Title
Executive Director
Phone
(601) 545-8700

Specialties & licenses 1

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

Addresses

Primary practice location

404 Lillie Burney St
Hattiesburg, MS 39401-5505

Mailing address

PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-8700

Other names 1

  • Hattiesburg Public School and Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040319000300 MS Part B Supplier - Clinic/Group Practice 2466342605 Receives reassigned benefits from 59 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brooklyn, MS; Sumrall, MS; Seminary, MS; Picayune, MS; Petal, MS; New Augusta, MS; Lumberton, MS; Hattiesburg, MS…
O20040515000239 MS Part A Provider - Federally Qualified Health Center (FQHC) 2466342605 Practice locations: Hattiesburg, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023087400. Details of each certification follow.

Federally qualified health center certification: CCN 251934

Legal name
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Doing business as
HATTIESBURG PUBLIC SCHOOL AND COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 18, 2004
Last certification
May 18, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in MS
Enrollment address
404 Lillie Burney St
Hattiesburg, MS 39401-5505

Other NPIs on the same Medicare enrollment 19

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

View all 19

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1025504Hattiesburg School and Community Clinic404 Lillie Burney Street, Hattiesburg, MS 39401Provider-performed microscopyMay 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
N R Burger School and Community Clinic59 organizations share this tax ID, including this one
Part of
N R Burger School and Community Clinic

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

500 Martin Luther King Ave
Hattiesburg, MS 39401
Phone (601) 583-0960

62 Old Airport Rd
Hattiesburg, MS 39401
Phone (601) 544-4550

693 Eatonville Rd
Hattiesburg, MS 39401
Phone 60125526602217

16 Ada Bounds Dr
Lumberton, MS 39455
Phone (601) 796-3721

424 Martin Luther King Dr
Rm 5A
Purvis, MS 39475

Networks

  • devoted network organization-5b6e8479-727f-40cf-ba4e-9b59e43aa45e

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Larry Davis Individual Corporate DirectorBoard Member Apr 27, 2021
Deborah Gambrell Individual Corporate DirectorBoard Member Jun 27, 2023
Karen Speed Individual Corporate DirectorBoard Member Jun 29, 2004
Sherlita Babineaux Individual Corporate DirectorBoard Member Oct 31, 2023
Nanni Freeman Individual Corporate DirectorBoard Member Apr 2, 2005
Southeast Mississippi Rural Health Initiative, Inc. Organization, Hattiesburg, MS Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest May 29, 1979 100%
Maxine Bolton Individual Corporate DirectorBoard Member - Vice President Oct 28, 2014
Janice Robinson Individual Corporate OfficerCeo Jan 23, 2023 100%
Corporate DirectorCeo Jan 23, 2023 100%
W-2 Managing EmployeeCeo Jan 23, 2023 100%
Virginia Burks Individual Corporate DirectorBoard Member Jan 1, 1995
Joyce Woullard Individual Corporate DirectorBoard Member - Treasurer Sep 26, 1995
Derrick Autmon Individual Corporate DirectorBoard Member - President Jun 23, 2015
Terry King Individual Corporate DirectorBoard Member Jun 27, 2023

All facility ownership & control disclosures 36

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Woodley Elementary SchoolHattiesburg, MS, CCN 251942 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Hattiesburg High School and Community ClinicHattiesburg, MS, CCN 251943 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
N. R. Burger School and Community ClinicHattiesburg, MS, CCN 251941 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Minor Care ClinicHattiesburg, MS, CCN 251961 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Picayune Family Health CenterPicayune, MS, CCN 251966 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Lumberton Family Health CenterLumberton, MS, CCN 251865 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Brooklyn Family Health CenterBrooklyn, MS, CCN 251864 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
New Augusta Family Health CenterNew Augusta, MS, CCN 251816 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Women's Health CenterHattiesburg, MS, CCN 251874 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Hattiesburg Family Health CenterHattiesburg, MS, CCN 251849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Seminary Family Health CenterSeminary, MS, CCN 251814 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Elementary SchoolPetal, MS, CCN 251013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Primary SchoolPetal, MS, CCN 251017 Federally qualified health center Operational/Managerial Control (100%) May 29, 1979
Petal Upper Elementary SchoolPetal, MS, CCN 251016 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Middle SchoolPetal, MS, CCN 251012 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Petal High SchoolPetal, MS, CCN 251015 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Hattiesburg High School CampusHattiesburg, MS, CCN 251009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Petal School ClinicPetal, MS, CCN 251023 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Semrhi Support Service CenterHattiesburg, MS, CCN 251070 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Forrest County Agricultural High SchoolBrooklyn, MS, CCN 251068 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Baxterville School (K -8)Lumberton, MS, CCN 251129 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Purvis Lower Elementary SchoolPurvis, MS, CCN 251132 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Oak Grove LongleafHattiesburg, MS, CCN 251133 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis High SchoolPurvis, MS, CCN 251145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 14, 2022
Sumrall Elementary SchoolSumrall, MS, CCN 251136 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Lamar County School ClinicPurvis, MS, CCN 251138 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove ElementaryHattiesburg, MS, CCN 251146 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Sumrall High SchoolSumrall, MS, CCN 251147 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Sumrall Middle SchoolSumrall, MS, CCN 251139 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis Middle SchoolPurvis, MS, CCN 251142 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove High SchoolHattiesburg, MS, CCN 251141 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove Middle SchoolHattiesburg, MS, CCN 251131 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Lumberton ElementaryLumberton, MS, CCN 251130 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis Upper Elementary SchoolPurvis, MS, CCN 251135 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Lumberton High SchoolLumberton, MS, CCN 251144 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Bellevue ElementaryHattiesburg, MS, CCN 251152 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979

Facilities with the same owner 36

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 36

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1023087400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-8700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 LILLIE BURNEY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394015505",
            "telephone_number": "601-450-6500",
            "fax_number": "601-450-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG PUBLIC SCHOOL AND COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC",
        "enumeration_date": "2006-03-16",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-545-8700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hattiesburg Public School and Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hattiesburg Public School and Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.