JFMC Heidelberg, LLC
Organization Active NPI Primary Care Clinic/Center · Heidelberg, MS
NPI 1083074959 · NPPES record last updated Jun 2, 2016
Key facts
- NPI
- 1083074959
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- JFMC HEIDELBERG, LLC
- Practice address
- 1208 Academy Dr
Heidelberg, MS 39439 - Phone
- (601) 787-4906
- Fax
- (601) 787-4909
- NPI assigned
- Mar 4, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- JONES FAMILY MEDICINE CLINIC, PLLC
Authorized official
- Name
- Kaye Jones
- Title
- Business Manager
- Phone
- (601) 425-0092
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 6
Practitioners 20
-
Deirdre Atkins, FNP-C
-
Lauren Brewer Beckman, AGPCNP
-
Dorita Jane Blair, APRN
-
Jarrod Edward Gant, DHA,DNP, APRN, FNP-C
-
Thomas Neil Hudson, FNP
-
Brandi Jefferson, NP
-
Morgan Jones, FNP
-
Kelley Quinn, NP
-
Amber Ryals, NP
-
Kelsa Shirley, FNP
-
Lelia Marie Simpson, FNP-C
-
Robert Josh Wansley, CFNP
-
Shannon Creel Weathers, FNP-C
-
Melissa Wheaton, FNP-BC
-
John Bernard Harris IV, AGACNP-BC
-
Crystal Stephens, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2112306 | JFMC Heidelberg | Certificate of waiver | Apr 25, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050921000315 | MS | Part B Supplier - Clinic/Group Practice | 6406880368 |
Receives reassigned benefits from 24 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bay Springs, MS; Quitman, MS; Laurel, MS; Heidelberg, MS; Ellisville, MS |
National Provider Directory
- Tax ID family
- Jones Family Medicine Clinic PLLC
- Part of
- Jones Family Medicine Clinic PLLC
Locations
85 Hal Crocker Rd
Ellisville, MS 39437
Phone (601) 719-0092
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
1208 Academy Dr
Heidelberg, MS 39439
Mailing address
1208 Academy Dr
Heidelberg, MS 39439
Phone (601) 787-4906
Other providers in Heidelberg, MS
- Joyce Denise Barker
- Family Home Care, LLC
- Gods Blessing Home Health
- Chiara S Gressett
- Hattiesburg Clinic PA
- Paula McDonald
- Mississippi State Department of Health
- Outreach Health Services,Inc.
- Caldonia Livingston Satcher
- Toneshia Lakia Smith
All providers in Heidelberg, MS · Primary Care Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2016. 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.
- 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.