NPIMap

Organization Active NPI

Aaron E. Henry Community Health

  • Federally Qualified Health Center (FQHC)
  • Clarksdale, MS
National Provider Identifier
1104574847
Registry record updated Aug 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AARON E. HENRY COMMUNITY HEALTH
Practice address
600 Ohio Ave
Clarksdale, MS 38614-6020
Phone
(662) 624-4292
Fax
(662) 351-3303
NPI assigned
Mar 11, 2022
Organization subpart
Yes
Parent organization
AARON E. HENRY COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2022

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

Authorized official

Name
Candace L Fondren
Title
Revenue Cycle Manager
Phone
(662) 624-4292

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

600 Ohio Ave
Clarksdale, MS 38614-6020

Mailing address

PO Box 1216
Clarksdale, MS 38614-1216
Phone (662) 624-4292

Other identifiers 1

IdentifierTypeStateIssuer
09010039MedicaidMS

Other names 1

  • Aurelia Jones - Taylor Administrative Complex Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL aaronehenry@aehchc.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040330001267 MS Part B Supplier - Clinic/Group Practice 1153230560 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Batesville, MS; Clarksdale, MS; Tunica, MS

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Aaron E Henry Community Health18 organizations share this tax ID, including this one
Part of
Aaron E Henry Community Health

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 2

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": "1646956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1104574847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1216",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386141216",
            "telephone_number": "662-624-4292",
            "fax_number": "662-351-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 OHIO AVE",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146020",
            "telephone_number": "662-624-4292",
            "fax_number": "662-351-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AARON E. HENRY COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AARON E. HENRY COMMUNITY HEALTH",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "FONDREN",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "662-624-4292"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "09010039",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "aaronehenry@aehchc.org",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "600 Ohio Ave",
            "city": "Clarksdale",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386146020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Aurelia Jones - Taylor Administrative Complex",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Aurelia Jones - Taylor Administrative Complex",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.