Strayhorn Family Medical Clinic, LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

STRAYHORN FAMILY MEDICAL CLINIC, LLC

Practice address

3509 Highway 4 W
Sarah, MS 38665-3567

Phone

(662) 292-7651

NPI assigned

Mar 11, 2019

Organization subpart

No

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

Authorized official

Name

Robynn Ross, FNPNPI 1043634744

Title

Owner

Phone

(662) 612-6411

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19510/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robynn Elizabeth Ross

  • Family Nurse Practitioner
  • Sarah, MS
  • NPI 1043634744
  Medicare reassignment Care Compare group NPD Authorized official
• Anita Golden-Simmons, FNP

  • Family Nurse Practitioner
  • Senatobia, MS
  • NPI 1831193440
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1245798008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 HIGHWAY 4 W",
            "city": "SARAH",
            "state": "MS",
            "postal_code": "386653567",
            "telephone_number": "662-612-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 HIGHWAY 4 W",
            "city": "SARAH",
            "state": "MS",
            "postal_code": "386653567",
            "telephone_number": "662-292-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRAYHORN FAMILY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-11",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "ROBYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-612-6411",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04733217",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lionel Jay Johnson
• Robynn Elizabeth Ross
• Tate County Hospital (Highland Hills Medical Associates of Strayhorn)

• Primary Care Nurse Practitioner in Sarah, MS
• Providers in Sarah, MS by specialty
• Primary Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.