NPIMap

Organization Active NPI

G a Carmichael Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Carthage, MS
National Provider Identifier
1043974033
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Practice address
303 W Franklin St
Carthage, MS 39051-3703
Phone
(601) 859-5213
Fax
(601) 859-8771
NPI assigned
Oct 26, 2021
Organization subpart
Yes
Parent organization
G A CARMICHAEL FAMILY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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

Authorized official

Name
Mr. Joseph Davis, MHA
Title
Chief Operation Officer
Phone
(601) 859-5213

Specialties & licenses 1

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

Addresses

Primary practice location

303 W Franklin St
Carthage, MS 39051-3703

Mailing address

1668 W Peace St
Canton, MS 39046-5332
Phone (601) 859-5213

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050816001055 MS Part B Supplier - Clinic/Group Practice 2567371032 Receives reassigned benefits from 24 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Belzoni, MS; Yazoo City, MS; Vaughan, MS; Greenwood, MS; Carthage, MS; Canton, MS; Bentonia, MS
O20220211001342 MS Part A Provider - Federally Qualified Health Center (FQHC) 2567371032 Practice locations: Carthage, MS
O20240125004530 MS MDPP Supplier - in-Person MDPP Supplier 2567371032 Practice locations: Carthage, MS

Federally qualified health center certification: CCN 251143

Legal name
G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 19, 2022
Last certification
Oct 19, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 18, 1973 in MS
Enrollment address
303 W Franklin St
Carthage, MS 39051-3703

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Ga Carmichael Fam HLTH Ctr25 organizations share this tax ID, including this one
Part of
Ga Carmichael Fam HLTH Ctr

Other organizations with this tax ID 24

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

View all 24

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
William Edwards Individual Operational/Managerial ControlCfo Dec 1, 2018
G a Carmichael Family Health Center, Inc. Organization, Canton, MS Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 26, 2021
James Coleman Individual Corporate OfficerCeo Jun 1, 2016
Corporate DirectorCeo Jun 1, 2016
Joseph Davis Individual Corporate DirectorCoo Jan 1, 2016

Owners & managing parties with NPI records 15

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 15

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
G a Carmichael Family Health Center, IncGreenwood, MS, CCN 251158 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 26, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635206400000",
    "number": "1043974033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1668 W PEACE ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390465332",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-5771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 W FRANKLIN ST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390513703",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G A CARMICHAEL FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "G A CARMICHAEL FAMILY HEALTH CENTER, INC.",
        "enumeration_date": "2021-10-26",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF OPERATION OFFICER",
        "authorized_official_telephone_number": "601-859-5213",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA"
    },
    "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 Carthage, MS

Sources for this page

Verify at the official NPI Registry.