NPIMap

Organization Active NPI

G a Carmichael Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Belzoni, MS
National Provider Identifier
1235295304
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
G A CARMICHAEL FAMILY HEALTH CENTER INC
Practice address
1301 E First St
Belzoni, MS 39038
Phone
(622) 247-1252
Fax
(601) 859-8771
NPI assigned
Dec 30, 2006
Last updated
Oct 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Dr. James L. Coleman Jr., ED.D
Title
Ceo
Phone
(601) 859-5213

Specialties & licenses 1

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

Addresses

Primary practice location

1301 E First St
Belzoni, MS 39038

Mailing address

PO Box 588
Canton, MS 39046-0588
Phone (601) 859-5213

Other identifiers 1

IdentifierTypeStateIssuer
09013114MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050816001055 MS Part B Supplier - Clinic/Group Practice 2567371032 Receives reassigned benefits from 24 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Belzoni, MS; Yazoo City, MS; Vaughan, MS; Greenwood, MS; Carthage, MS; Canton, MS; Bentonia, MS
O20101213000730 MS Part A Provider - Federally Qualified Health Center (FQHC) 2567371032 Practice locations: Belzoni, MS
O20231228002761 MS MDPP Supplier - in-Person MDPP Supplier 2567371032 Practice locations: Belzoni, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235295304. Details of each certification follow.

Federally qualified health center certification: CCN 251823

Legal name
G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1973 in MS
Enrollment address
1301 E First St
Belzoni, MS 39038-3436

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 17

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

View all 17

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
25D0973101G a Carmichael Family Health Center1301 W First St, Belzoni, MS 39038Certificate of waiverJul 4, 2027

National Provider Directory

National Provider Directory

Locations

16463 US Highway 49
Belzoni, MS 39038
Phone (662) 247-1252

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Rosie Evan-Williams Individual Corporate DirectorBoard Member Aug 30, 2017
William Edwards Individual Operational/Managerial ControlCfo Dec 1, 2019
James Coleman Individual Corporate OfficerCeo Jun 1, 2016
W-2 Managing EmployeeCeo Jun 1, 2016
Maurice Lawson Individual Corporate DirectorBoard Member Aug 30, 2017
Enrique Cecilio Diaz Individual Corporate DirectorBoard Member Aug 30, 2017
Joseph Davis Individual Corporate DirectorCoo Jun 1, 2026
W-2 Managing EmployeeCoo Jun 1, 2016
Phyllis Bell-Luckett Individual Corporate DirectorBoard Member Aug 30, 2017
Gregory Moseley Individual Corporate DirectorBoard Member Aug 30, 2017
Deloris Harris Individual Corporate DirectorBoard Member Aug 30, 2017
Luis Montgomery Individual Corporate DirectorBoard Member Aug 30, 2017
Charles Henderson Individual Corporate DirectorBoard Member Aug 30, 2017
Arnel Devon Bolden Individual Corporate DirectorBoard Member Aug 30, 2017
Veda Horton Individual Corporate DirectorBoard Member Aug 30, 2017
Jeremy McCoy Individual Corporate DirectorBoard Member Aug 30, 2017
Karl Sykes Individual Corporate DirectorBoard Member Aug 30, 2017

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
G a Carmichael Family Health Center, Inc.Carthage, MS, CCN 251143 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 26, 2021
G a Carmichael Family Health Center, IncGreenwood, MS, CCN 251158 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 26, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1167436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1235295304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 588",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390460588",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 E FIRST ST",
            "city": "BELZONI",
            "state": "MS",
            "postal_code": "39038",
            "telephone_number": "622-247-1252",
            "fax_number": "601-859-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G A CARMICHAEL FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-30",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-859-5213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "ED.D"
    },
    "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": "09013114",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belzoni, MS

Sources for this page

Verify at the official NPI Registry.