NPIMap

Organization Active NPI

Sumrall Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Sumrall, MS
National Provider Identifier
1184694036
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUMRALL FAMILY HEALTH CENTER
Doing business as
Sumrall Family Health Center
Practice address
1016 Highway 42
Sumrall, MS 39482-9634
Phone
(601) 758-4214
Fax
(601) 758-0614
NPI assigned
Jan 24, 2006
Last updated
Feb 5, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

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

Authorized official

Name
Janice Robinson, CEO
Title
Chief Executive Officer
Phone
(601) 545-8700

Specialties & licenses 1

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

Addresses

Primary practice location

1016 Highway 42
Sumrall, MS 39482-9634

Mailing address

PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-3700

Other identifiers 1

IdentifierTypeStateIssuer
009013879MedicaidMS

Other names 1

  • Sumrall Family Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040319000300 MS Part B Supplier - Clinic/Group Practice 2466342605 Receives reassigned benefits from 59 practitioners
19 other NPIs on this enrollment
Practice locations: Brooklyn, MS; Sumrall, MS; Seminary, MS; Picayune, MS; Petal, MS; New Augusta, MS; Lumberton, MS; Hattiesburg, MS…
O20091204000212 MS Part A Provider - Federally Qualified Health Center (FQHC) 2466342605 Practice locations: Sumrall, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184694036. Details of each certification follow.

Federally qualified health center certification: CCN 251815

Legal name
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Doing business as
SUMRALL FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1992
Last certification
Jul 1, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 29, 1979 in MS
Enrollment address
1016 Highway 42
Sumrall, MS 39482-9634

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Bellevue Elementary59 organizations share this tax ID, including this one
Part of
Bellevue Elementary

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Locations

1300 Beaumont Brooklyn Rd
Beaumont, MS 39423
Phone (601) 784-3393

2006 Oferral St
Hattiesburg, MS 39401
Phone (601) 583-8112

2543 Old Highway 24
Hattiesburg, MS 39402
Phone (601) 264-4634

526 Forrest St
Hattiesburg, MS 39401
Phone (601) 583-4311

1145 Highway 42
Petal, MS 39465
Phone (601) 544-0500

60 Herrington Rd
Petal, MS 39465
Phone (601) 554-7244

310 Mitchell Ave
Purvis, MS 39475
Phone (601) 794-2959

1217 Highway 42
Sumrall, MS 39482
Phone (601) 758-4416

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
Larry Davis Individual Corporate DirectorBoard Member Apr 27, 2021
Deborah Gambrell Individual Corporate DirectorBoard Member Jun 27, 2023
Karen Speed Individual Corporate Director Jun 29, 2004
Sherlita Babineaux Individual Corporate DirectorBoard Member Oct 31, 2023
Nanni Freeman Individual Corporate Director Apr 26, 2005
Maxine Bolton Individual Corporate Director Oct 28, 2014
Janice Robinson Individual Corporate OfficerCeo Jan 23, 2023 100%
Corporate DirectorCeo Jan 23, 2023 100%
W-2 Managing EmployeeCeo Jan 23, 2023 100%
Virginia Burks Individual Corporate Director Jan 1, 1995
Joyce Woullard Individual Corporate Director Sep 26, 1995
Derrick Autmon Individual Corporate DirectorBoard Member Jun 23, 2015
Terry King Individual Corporate DirectorBoard Member Jun 27, 2023

All facility ownership & control disclosures 37

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

FacilityTypeRoleSince
Hattiesburg Public School and Community ClinicHattiesburg, MS, CCN 251934 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Woodley Elementary SchoolHattiesburg, MS, CCN 251942 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Hattiesburg High School and Community ClinicHattiesburg, MS, CCN 251943 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
N. R. Burger School and Community ClinicHattiesburg, MS, CCN 251941 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Minor Care ClinicHattiesburg, MS, CCN 251961 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Picayune Family Health CenterPicayune, MS, CCN 251966 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Lumberton Family Health CenterLumberton, MS, CCN 251865 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Brooklyn Family Health CenterBrooklyn, MS, CCN 251864 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
New Augusta Family Health CenterNew Augusta, MS, CCN 251816 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Women's Health CenterHattiesburg, MS, CCN 251874 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Hattiesburg Family Health CenterHattiesburg, MS, CCN 251849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Seminary Family Health CenterSeminary, MS, CCN 251814 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Elementary SchoolPetal, MS, CCN 251013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Primary SchoolPetal, MS, CCN 251017 Federally qualified health center Operational/Managerial Control (100%) May 29, 1979
Petal Upper Elementary SchoolPetal, MS, CCN 251016 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Middle SchoolPetal, MS, CCN 251012 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Petal High SchoolPetal, MS, CCN 251015 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Hattiesburg High School CampusHattiesburg, MS, CCN 251009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Petal School ClinicPetal, MS, CCN 251023 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Semrhi Support Service CenterHattiesburg, MS, CCN 251070 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Forrest County Agricultural High SchoolBrooklyn, MS, CCN 251068 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Baxterville School (K -8)Lumberton, MS, CCN 251129 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Purvis Lower Elementary SchoolPurvis, MS, CCN 251132 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Oak Grove LongleafHattiesburg, MS, CCN 251133 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis High SchoolPurvis, MS, CCN 251145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 14, 2022
Sumrall Elementary SchoolSumrall, MS, CCN 251136 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Lamar County School ClinicPurvis, MS, CCN 251138 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove ElementaryHattiesburg, MS, CCN 251146 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Sumrall High SchoolSumrall, MS, CCN 251147 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Sumrall Middle SchoolSumrall, MS, CCN 251139 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis Middle SchoolPurvis, MS, CCN 251142 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove High SchoolHattiesburg, MS, CCN 251141 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove Middle SchoolHattiesburg, MS, CCN 251131 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Lumberton ElementaryLumberton, MS, CCN 251130 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis Upper Elementary SchoolPurvis, MS, CCN 251135 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Lumberton High SchoolLumberton, MS, CCN 251144 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Bellevue ElementaryHattiesburg, MS, CCN 251152 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979

Practitioners & affiliated clinicians

Practitioners 61

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.

View all 61

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1184694036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-3700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 HIGHWAY 42",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "394829634",
            "telephone_number": "601-758-4214",
            "fax_number": "601-758-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMRALL FAMILY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC",
        "enumeration_date": "2006-01-24",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "601-545-8700",
        "authorized_official_credential": "CEO"
    },
    "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": "009013879",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sumrall Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sumrall Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sumrall, MS

Sources for this page

Verify at the official NPI Registry.