Active NPI
Och Family Practice Ackerman
- Primary Care Clinic/Center
- Ackerman, MS
National Provider Identifier
1114189644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- License
- 11-269
- Legal business name
- OCH FAMILY PRACTICE ACKERMAN
- Practice address
- 356 E Cherry St
Ackerman, MS 39735-9794 - Phone
- (662) 285-3243
- Fax
- (662) 285-3613
- NPI assigned
- Jun 26, 2008
- Organization subpart
- Yes
- Parent organization
- OKTIBBEHA COUNTY HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. James H. Jackson Jr.
- Title
- Ceo
- Phone
- (662) 615-2500
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 11-269 | MS | Primary |
Addresses
Primary practice location
356 E Cherry St
Ackerman, MS 39735-9794
Mailing address
PO Box 1327
Starkville, MS 39760-1327
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09409725 | Medicaid | MS |
Other names 1
- Parsons Family Medical Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081027000603 | MS | Part B Supplier - Clinic/Group Practice | 9436217940 |
Receives reassigned benefits from 2 practitioners Practice locations: Ackerman, MS |
National Provider Directory
National Provider Directory- Part of
- Oktibbeha Co Hospital
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": "1214438400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1664755200000",
"number": "1114189644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1327",
"city": "STARKVILLE",
"state": "MS",
"postal_code": "397601327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "356 E CHERRY ST",
"city": "ACKERMAN",
"state": "MS",
"postal_code": "397359794",
"telephone_number": "662-285-3243",
"fax_number": "662-285-3613"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OCH FAMILY PRACTICE ACKERMAN",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OKTIBBEHA COUNTY HOSPITAL",
"enumeration_date": "2008-06-26",
"last_updated": "2022-10-03",
"certification_date": "2022-10-03",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "H.",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "662-615-2500",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "MS",
"license": "11-269",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09409725",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Parsons Family Medical Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ackerman, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.