Central Mississippi Civic Improvement Association, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Raymond, MS
NPI 1023586609 · NPPES record last updated Dec 12, 2023
Key facts
- NPI
- 1023586609
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
- Practice address
- 417 Palestine St
Raymond, MS 39154-7618 - Phone
- (601) 362-5321
- NPI assigned
- Nov 13, 2018
- Organization subpart
- No
Authorized official
- Name
- Jasmin Chapman, DDS
- Title
- Ceo
- Phone
- (601) 364-5142
Corporate family (same tax ID) 37
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2249739 | Raymond Elementary School | Certificate of waiver | Jan 20, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Federally qualified health center certification: CCN 251083
- Legal name
- CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 23, 2019
- Last certification
- Jan 23, 2019
- Ownership / control type
- For profit – partnership
- Organization structure
- Other · Non-profit
- Incorporated
- Oct 6, 1970 in MS
- Enrollment address
- 417 Palestine St
Raymond, MS 39154-7618
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Jasmin O Chapman |
Corporate Officer |
Dec 29, 1998 | |
| W-2 Managing Employee |
Dec 29, 1998 | ||
| Ethel L Singleton |
Corporate Director |
Mar 17, 1986 | |
| Connie a Jones |
Corporate Director |
Jan 12, 2004 | |
| Lois C Christian |
Corporate Director |
Aug 21, 2006 | |
| John Marshall Lusk |
Corporate Director | Apr 17, 2023 | |
| John Wicks |
Corporate Director | Apr 17, 2023 | |
| Christopher Gray |
Corporate Director | Apr 17, 2023 | |
| Frances a Frazier |
Corporate Director |
Nov 5, 2002 | |
| Lillie Ervin |
Corporate Director |
Aug 19, 1985 | |
| Heraclio Aguilar |
Corporate Director | Apr 17, 2023 | |
| Larry D McMillian |
Corporate Director |
Apr 21, 1997 | |
| Mary Thompson |
Corporate Director | Jul 18, 2022 | |
| Alberta Johnson |
Corporate Director |
Jan 14, 2002 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Jackson-Hinds Comprehensive Health Center -School Based Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 1, 2012 |
| Jackson-Hinds Comprehensive Health Center-Terry High School Based Clin |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Oct 1, 1972 |
| Gary Road Intermediate School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
May 1, 2017 May 1, 2017 |
| Jackson-Hinds Comprehensive Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jan 1, 2019 Dec 1, 2012 |
| Central Mississippi Civic Improvement Association, Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190123002798 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 4183533235 | Practice locations: Raymond, MS |
National Provider Directory
- Tax ID family
- Central Mississippi Improvement Association
Locations
417 Palestine St
Raymond, MS 39154
Phone 60136253211287
Networks
- devoted network organization-5b6e8479-727f-40cf-ba4e-9b59e43aa45e
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
417 Palestine St
Raymond, MS 39154-7618
Mailing address
3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321
Other names
- Raymond Elementary School
Other providers in Raymond, MS
- Cassie Thompson Brister
- Erica Denise Brown
- Canton Foot Clinic
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Martha Michelle Chambers
- Choice Wound Care
- Saloum Cisse
All providers in Raymond, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.