NPIMap

Organization Active NPI

Statcare PLLC

Doing business as STATCare Plus, Inc.

  • Family Medicine Physician
  • McComb, MS
National Provider Identifier
1194026260
Registry record updated Nov 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STATCARE PLLC
Doing business as
STATCare Plus, Inc.
Practice address
1015 Delaware Ave
Suite C
McComb, MS 39648-3827
Phone
(601) 249-4777
Fax
(601) 249-4776
NPI assigned
Nov 5, 2010
Last updated
Nov 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2021

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

Authorized official

Name
Debra Kennedy
Title
Administrator
Phone
(601) 250-1122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1015 Delaware Ave
Suite C
McComb, MS 39648-3827

Mailing address

1015 Delaware Ave
Suite C
McComb, MS 39648-3827
Phone (601) 249-4777

Other names 1

  • STATCare Plus, Inc. Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jharvey@sp-MS.direct.office.Nextgen.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040720000687 MS Part B Supplier - Clinic/Group Practice 5799764965 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McComb, MS; Summit, MS

Other NPIs on the same Medicare enrollment 1

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

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
25D2021481Statcare Plus, Inc1015 Delaware Avenue, Suite C, McComb, MS 39648Certificate of waiverMar 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Statcare PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1015 Delaware Ave
Ste C
McComb, MS 39648
Phone (601) 249-4777

1017 Delaware Ave
McComb, MS 39648
Phone (601) 250-1122

Interoperability endpoints

  • Direct secure messaging: jharvey@sp-ms.direct.office.nextgen.com

Practitioners & affiliated clinicians

Practitioners 12

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": "1288915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1194026260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 DELAWARE AVE",
            "address_2": "SUITE C",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483827",
            "telephone_number": "601-249-4777",
            "fax_number": "601-249-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 DELAWARE AVE",
            "address_2": "SUITE C",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483827",
            "telephone_number": "601-249-4777",
            "fax_number": "601-249-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-05",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-250-1122"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jharvey@sp-MS.direct.office.Nextgen.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1015 Delaware Ave",
            "address_2": "Suite C",
            "city": "McComb",
            "state": "MS",
            "country_code": "US",
            "postal_code": "396483827",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "STATCare Plus, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McComb, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.