NPIMap

Organization Active NPI

Family Health Care Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Prentiss, MS
National Provider Identifier
1144246398
Registry record updated Apr 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH CARE CLINIC, INC.
Practice address
910 Second Street
Prentiss, MS 39474
Phone
(601) 792-2078
Fax
(601) 792-8211
NPI assigned
Jul 14, 2006
Last updated
Apr 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2020

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

Authorized official

Name
Karina Marie Clayton
Title
Chief Financial Officer
Phone
(601) 825-7280

Specialties & licenses 1

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

Addresses

Primary practice location

910 Second Street
Prentiss, MS 39474

Mailing address

PO Box 24116
Jackson, MS 39225-4116
Phone (601) 825-7280

Other identifiers 1

IdentifierTypeStateIssuer
09014311MedicaidMS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040831001179 MS Part B Supplier - Clinic/Group Practice 5395656946 Receives reassigned benefits from 71 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monticello, MS; Pearl, MS; Newhebron, MS; Pelahatchie, MS; Piney Woods, MS; Pinola, MS; Prentiss, MS; Raleigh, MS…
O20080303000381 MS Part A Provider - Federally Qualified Health Center (FQHC) 5395656946 Practice locations: Prentiss, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144246398. Details of each certification follow.

Federally qualified health center certification: CCN 251855

Legal name
FAMILY HEALTH CARE CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 1, 1996
Last certification
Feb 1, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 30, 1996 in MS
Enrollment address
910 Second St
Prentiss, MS 39474-9117

Other NPIs on the same Medicare enrollment 37

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

View all 37

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1014745Family Health Care Clinic Inc - Prentiss910 Second Street, Prentiss, MS 39474Provider-performed microscopyApr 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Family Health Care Clinic Inc36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Margaret a Gray Individual Corporate OfficerPresident and Ceo Feb 1, 1992
W-2 Managing EmployeePresident and Ceo Feb 1, 1992
Charles Hatten Individual Corporate DirectorBoard of Directors Nov 1, 2015
Michael Howard Individual Corporate DirectorBoard of Directors Nov 1, 2015
Helen Johnson Individual Corporate DirectorBoard of Directors Nov 1, 2015
Louise Patterson Individual Corporate DirectorBoard of Directors Nov 1, 2015
Moses Johnson Individual Corporate DirectorBoard of Directors Nov 1, 2015
Annie Posey Individual Corporate DirectorBoard of Directors Nov 1, 2015
Carolyn Hartzog Individual Corporate DirectorBoard of Directors Nov 1, 2015
Lydia Gonzalez-Seals Individual Corporate DirectorBoard of Directors Nov 1, 2015
Cindy Bryan Individual Corporate DirectorBoard of Directors Nov 1, 2015
Eddie Thames Individual Corporate DirectorBoard of Directors Nov 1, 2015

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Family Health Care Clinic IncRussellville, AL, CCN 011965 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncMuscle Shoals, AL, CCN 011970 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncDecatur, AL, CCN 011967 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncTown Creek, AL, CCN 011966 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncFlorence, AL, CCN 011969 Federally qualified health center Operational/Managerial Control Aug 1, 2009
Family Health Care Clinic IncRogersville, AL, CCN 011971 Federally qualified health center Operational/Managerial Control Aug 1, 2009

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": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586995200000",
    "number": "1144246398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24116",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392254116",
            "telephone_number": "601-825-7280",
            "fax_number": "601-825-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 SECOND STREET",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "39474",
            "telephone_number": "601-792-2078",
            "fax_number": "601-792-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CARE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "KARINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "601-825-7280"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014311",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prentiss, MS

Sources for this page

Verify at the official NPI Registry.