NPIMap

Organization Active NPI

Healthy Living Family Medical Center LLC

  • Rural Health Clinic/Center
  • Gunnision, MS
National Provider Identifier
1154845840
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HEALTHY LIVING FAMILY MEDICAL CENTER LLC
Practice address
820 Ashland Avenue
Gunnision, MS 38746
Phone
(662) 987-5023
Fax
(662) 987-5025
NPI assigned
Aug 3, 2017
Last updated
Feb 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Authorized official

Name
Wycondaroga E Thomas, FNP-CNPI 1184091894
Title
Nurse Practitioner/Owner
Phone
(662) 402-0174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 890243 MS

Addresses

Primary practice location

820 Ashland Avenue
Gunnision, MS 38746

Mailing address

PO Box 357
Gunnison, MS 38746-0357
Phone (662) 987-5023

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170918002897 MS Part B Supplier - Clinic/Group Practice 7911271747 Practice locations: Gunnison, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154845840. Details of each certification follow.

Rural health clinic certification: CCN A53800

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HEALTHY LIVING FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 30, 2020
Last certification
Jul 30, 2020
Ownership / control type
2A
Facility address
820 Ashland Avenue / PO Box 357
Gunnison, MS 38746

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19142/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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": "1501718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675382400000",
    "number": "1154845840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 357",
            "city": "GUNNISON",
            "state": "MS",
            "postal_code": "387460357",
            "telephone_number": "662-987-5023",
            "fax_number": "662-987-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 ASHLAND AVENUE",
            "city": "GUNNISION",
            "state": "MS",
            "postal_code": "38746",
            "telephone_number": "662-987-5023",
            "fax_number": "662-987-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIVING FAMILY MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-03",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "WYCONDAROGA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "662-402-0174",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "890243",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.