Aberdeen Health Clinic Inc

Key facts

NPI

1083767271

Entity type

Organization (NPI type 2)

Primary specialty

Rural Health Clinic/Center 261QR1300X

Legal business name

ABERDEEN HEALTH CLINIC INC

Practice address

501 Chestnut Street
Aberdeen, MS 39730

Phone

(662) 369-6131

Fax

(662) 369-4588

NPI assigned

Jan 19, 2007

Organization subpart

No

Authorized official

Name

Ms. Eunice Crump NPI 1730357559

Title

Owner Manager

Phone

(662) 369-6131

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Owners & managing parties with NPI records 1

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

• Norris Vincent Crump Sr., MD Internal Medicine Physician · Tupelo, MS · NPI 1841344892
  CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST

Practitioners 6

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

• Norris Vincent Crump Sr., MD Internal Medicine Physician · Tupelo, MS · NPI 1841344892
  Medicare reassignment NPD INTERNAL MEDICINE · MS
• Ebony J'Niya Harris, FNP-BC Family Nurse Practitioner · Tupelo, MS · NPI 1144107145
  Medicare reassignment NPD MS
• Thelma Jean McClenton, FNP Family Nurse Practitioner · Starkville, MS · NPI 1659459246
  Medicare reassignment NPD MS
• Eunice Crump, PHYSICAL THERAPIST Physical Therapist · Aberdeen, MS · NPI 1730357559
  NPD Authorized official
• Trinity Sharda' Johnson, FNP Family Nurse Practitioner · West Point, MS · NPI 1427785849
  NPD (past) INTERNAL MEDICINE
• Valerie Long, NURSE PRACTITIONER Family Nurse Practitioner · Aberdeen, MS · NPI 1134397961
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled (2 enrollments) in MS

Rural health clinic certification: CCN 253938

Legal name

ABERDEEN HEALTH CLINIC INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 12, 1994

Last certification

Nov 17, 2021

Ownership / control type

1B

Organization structure

Corporation · Proprietary

Incorporated

Sep 28, 1994 in MS

Enrollment address

501 South Chestnut Street
Aberdeen, MS 39730-3336

All disclosed owners & managing parties 2

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

Medicare enrollment records

National Provider Directory

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19804/brand/1/csg/1/fhir/r4

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 21, 2019.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571616000000",
    "number": "1083767271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 892",
            "address_2": "501 CHESTNUT STREET",
            "city": "ABERDEEN",
            "state": "MS",
            "postal_code": "39730",
            "telephone_number": "662-369-6131",
            "fax_number": "662-369-4588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 CHESTNUT STREET",
            "city": "ABERDEEN",
            "state": "MS",
            "postal_code": "39730",
            "telephone_number": "662-369-6131",
            "fax_number": "662-369-4588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABERDEEN HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2019-10-21",
        "status": "A",
        "authorized_official_last_name": "CRUMP",
        "authorized_official_first_name": "EUNICE",
        "authorized_official_title_or_position": "OWNER MANAGER",
        "authorized_official_telephone_number": "662-369-6131",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "8243",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MS",
            "license": "R857916",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "C20194",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014086",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Aberdeen, MS · Rural Health Clinic/Center in Mississippi