NPIMap

Organization Active NPI

Aberdeen Health Clinic Inc

  • Rural Health Clinic/Center
  • Aberdeen, MS
National Provider Identifier
1083767271
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Oct 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Authorized official

Name
Ms. Eunice CrumpNPI 1730357559
Title
Owner Manager
Phone
(662) 369-6131

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 8243 MS
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X R857916 MS
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

501 Chestnut Street
Aberdeen, MS 39730

Mailing address

PO Box 892
501 Chestnut Street
Aberdeen, MS 39730
Phone (662) 369-6131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070906000189 MS Part A Provider - Rural Health Clinic 1153414263 Practice locations: Aberdeen, MS
O20110125000918 MS Part B Supplier - Clinic/Group Practice 1153414263 Receives reassigned benefits from 3 practitioners
Practice locations: Aberdeen, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083767271. Details of each certification follow.

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
CorporationProprietary
Incorporated
Sep 28, 1994 in MS
Enrollment address
501 South Chestnut Street
Aberdeen, MS 39730-3336

National Provider Directory

National Provider Directory

Locations

501 S Chestnut St
Aberdeen, MS 39730
Phone (662) 369-6110

Interoperability endpoints

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

Ownership & related parties

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.

NameRoleSinceShare
Norris V Crump Individual 5% Or Greater Direct Ownership InterestMedical Director Sep 28, 1994 100%
Eunice Crump Individual Corporate OfficerPresident Sep 28, 1994
W-2 Managing EmployeeOffice Manager Jun 1, 2015

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, MS

Sources for this page

Verify at the official NPI Registry.