NPIMap

Organization Active NPI

Rural Health Medical Program, Inc

Doing business as Demopolis Health Center

  • Federally Qualified Health Center (FQHC)
  • Demopolis, AL
National Provider Identifier
1114006848
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH MEDICAL PROGRAM, INC
Doing business as
Demopolis Health Center
Practice address
1502 Highway 80 East
Unit a
Demopolis, AL 36732
Phone
(334) 289-1193
NPI assigned
Nov 3, 2006
Last updated
Oct 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Authorized official

Name
Ms. Latoya Freeman
Title
HR Director
Phone
(334) 874-7428

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1502 Highway 80 East
Unit a
Demopolis, AL 36732

Mailing address

PO Box 2213
Selma, AL 36702-2213
Phone (334) 874-7428

Other identifiers 1

IdentifierTypeStateIssuer
630000008MedicaidAL

Other names 1

  • Demopolis Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040506001178 AL Part B Supplier - Clinic/Group Practice 0143219196 Receives reassigned benefits from 42 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Demopolis, AL; Marion, AL; Monroeville, AL; Pine Apple, AL; Selma, AL; Thomaston, AL; Uniontown, AL; Vredenburgh, AL…
O20181017003766 AL Part A Provider - Federally Qualified Health Center (FQHC) 0143219196 Practice locations: Demopolis, AL
O20200407001242 AL MDPP Supplier - in-Person MDPP Supplier 0143219196 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Camden, AL; Demopolis, AL; Marion, AL; Monroeville, AL; Pine Apple, AL; Selma, AL; Thomaston, AL; Uniontown, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114006848. Details of each certification follow.

Federally qualified health center certification: CCN 011045

Legal name
RURAL HEALTH MEDICAL PROGRAM, INC.
Doing business as
DEMOPOLIS HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2018
Last certification
Oct 17, 2018
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 7, 1978 in AL
Enrollment address
1502 Highway 80 East
Unit a
Demopolis, AL 36732

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Pine Apple Health Center10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jan Hayden Individual Corporate Director Mar 7, 2016
Don King Individual Corporate Director Apr 12, 2017
Debra Robinson Individual Corporate Director Oct 20, 2017
Brenda Blevins Individual Corporate Director Oct 20, 2017
Earnestine Burrell Individual Corporate Director Oct 20, 2017
Keshee Danee Smith Individual Corporate DirectorCeo Mar 7, 2016
W-2 Managing EmployeeCeo Mar 7, 2016
Alfred Haskin Individual Corporate Director Mar 28, 2017

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Uniontown Health ServicesUniontown, AL, CCN 011837 Federally qualified health center Operational/Managerial Control Jul 18, 2011
Pine Apple Health CenterPine Apple, AL, CCN 011836 Federally qualified health center Operational/Managerial Control Sep 17, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1114006848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2213",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367022213",
            "telephone_number": "334-874-7428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 HIGHWAY 80 EAST",
            "address_2": "UNIT A",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "36732",
            "telephone_number": "334-289-1193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH MEDICAL PROGRAM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "LATOYA",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "334-874-7428",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000008",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Demopolis Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Demopolis Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Demopolis, AL

Sources for this page

Verify at the official NPI Registry.