Internal Medicine Clinic of Columbia, P.a.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

INTERNAL MEDICINE CLINIC OF COLUMBIA, P.A.

Practice address

914 Sumrall Rd
Columbia, MS 39429-2652

Phone

(601) 731-1470

Fax

(601) 731-1474

NPI assigned

Jul 25, 2006

Last updated

Feb 18, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bryan F McCraw, M.D.NPI 1174547954

Title

President

Phone

(601) 731-1470

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205858263. Details of each certification follow.

• CCN 258902 Rural health clinic · Active · Details

Rural health clinic certification: CCN 258902

Legal name

INTERNAL MEDICINE CLINIC OF COLUMBIA, P.A.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

May 29, 1996

Last certification

Jan 25, 2022

Ownership / control type

1B

Organization structure

CorporationNon-profit

Incorporated

Jun 24, 1985 in MS

Enrollment address

914 Sumrall Rd
Columbia, MS 39429-2652

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jeffrey Neal Johnson, M.D.

  • Internal Medicine Physician
  • Columbia, MS
  • NPI 1689698318

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 7

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.

• Alicia Brister, CFNP

  • Family Nurse Practitioner
  • Columbia, MS
  • NPI 1336543305
  Medicare reassignment Care Compare group NPD
• Nancy F Easterling, CFNP

  • Nurse Practitioner
  • Columbia, MS
  • NPI 1568486124
  Medicare reassignment Care Compare group NPD
• Jeffrey Neal Johnson, M.D.

  • Internal Medicine Physician
  • Columbia, MS
  • NPI 1689698318
  Medicare reassignment Care Compare group NPD
• David Carroll Albritton, FNP-C

  • Family Nurse Practitioner
  • Soldotna, AK
  • NPI 1376187799

  MS

  Medicare reassignment NPD
• Bryan F McCraw, M.D.

  • Internal Medicine Physician
  • Columbia, MS
  • NPI 1174547954
  Authorized official Same address or phone
• Kevin H Holmes, M.D.

  • Internal Medicine Physician
  • Columbia, MS
  • NPI 1942297858
  NPD
• Johnny Bullock, MD

  • Family Medicine Physician
  • Foxworth, MS
  • NPI 1043268709
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455753600000",
    "number": "1205858263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 SUMRALL RD",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394292652",
            "telephone_number": "601-731-1470",
            "fax_number": "601-731-1474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 SUMRALL RD",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394292652",
            "telephone_number": "601-731-1470",
            "fax_number": "601-731-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE CLINIC OF COLUMBIA, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2016-02-18",
        "status": "A",
        "authorized_official_last_name": "MCCRAW",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-731-1470",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014377",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tony Lavelle Humphries, D. M. D.
• Harry G. Hunt, M.D.
• Lauren Hurst, NP
• Rhondalyn Ilori, RN, BSN
• Infinity Home Care LLC
• Essie Jackson
• Jonathan Ryohwan Jang, MD
• Corinthian Sharmeze Jefferson
• Angela E Jenkins, LPN
• Jennifer Trihoulis MD, LLC

• Rural Health Clinic/Center in Columbia, MS
• Providers in Columbia, MS by specialty
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.