NPIMap

Organization Active NPI

Oak Grove Longleaf

  • Federally Qualified Health Center (FQHC)
  • Hattiesburg, MS
National Provider Identifier
1053985226
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OAK GROVE LONGLEAF
Practice address
5279 W 4TH St
Hattiesburg, MS 39402-9700
Phone
(601) 264-3858
Fax
(601) 450-2493
NPI assigned
May 13, 2021
Reactivated
Jul 8, 2022
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Janice Robinson
Title
Ceo
Phone
(601) 545-8700

Corporate family (same tax ID) 18

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

View all 18

Facilities with the same owner 36

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

View all 36

Medicare participation

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

Federally qualified health center certification: CCN 251133

Medicare enrollment files
Legal name
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Doing business as
OAK GROVE LONGLEAF
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 1, 2022
Last certification
Sep 1, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in MS
Enrollment address
5279 W 4TH St
Hattiesburg, MS 39402-9700

All disclosed owners & managing parties 11

Medicare enrollment files

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 Mar 23, 2021
Karen Speed Individual Corporate DirectorBoard Member - President Jun 29, 2004
Nanni Freeman Individual Corporate DirectorBoard Member Apr 26, 2005
Southeast Mississippi Rural Health Initiative, Inc. Organization, Hattiesburg, MS Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2022 100%
Kermit Rayborn Individual Corporate DirectorBoard Member Oct 22, 1996
Maxine Bolton Individual Corporate DirectorBoard Member - Secretary 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%
Billy Folkes Individual Corporate DirectorBoard Member Feb 20, 2007
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 - Vice President Jun 23, 2015

All facility ownership & control disclosures 36

Medicare enrollment files

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

FacilityTypeRoleSince
Hattiesburg Public School and Community ClinicHattiesburg, MS, CCN 251934 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
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
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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20220909001806 MS Part a Provider - Federally Qualified Health Center (FQHC) 2466342605 Practice locations: Hattiesburg, MS

National Provider Directory

National Provider Directory
Tax ID family
Seminary Clinic (59 organizations share this tax ID)

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

5279 W 4TH St
Hattiesburg, MS 39402-9700

Mailing address

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
200002175MedicaidMS

Other names 1

NPPES NPI Registry
  • Oak Grove Longleaf Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 5, 2026.

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1053985226",
    "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": "5279 W 4TH ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394029700",
            "telephone_number": "601-264-3858",
            "fax_number": "601-450-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK GROVE LONGLEAF",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-13",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "deactivation_date": "2021-07-20",
        "reactivation_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-545-8700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200002175",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Grove Longleaf",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oak Grove Longleaf",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.