NPIMap

Organization Active NPI

Central Mississippi Civic Improvement Association, Inc.

Doing business as Jackson Hinds Comprehensive Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
National Provider Identifier
1255360483
Registry record updated Jul 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
Doing business as
Jackson Hinds Comprehensive Health Center
Practice address
1655 Whiting Rd
Jackson, MS 39209-5826
Phone
(601) 923-2547
NPI assigned
Jul 1, 2006
Last updated
Jul 9, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2009

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

Authorized official

Name
Dr. Jasmin Chapman, DDSNPI 1811931363
Title
Ceo
Phone
(601) 362-5321

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1655 Whiting Rd
Jackson, MS 39209-5826

Mailing address

3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321

Other identifiers 1

IdentifierTypeStateIssuer
05356512MedicaidMS

Other names 1

  • JACKSON HINDS COMPREHENSIVE HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030331000011 MS Part A Provider - Federally Qualified Health Center (FQHC) 4183533235 Practice locations: Jackson, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255360483. Details of each certification follow.

Federally qualified health center certification: CCN 251911

Legal name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Doing business as
JACKSON-HINDS VAN WINKLE ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 28, 2003
Last certification
Feb 28, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 7, 1970 in MS
Enrollment address
1655 Whiting Rd
Jackson, MS 39209-5826
Related CCNs
251830

Facilities connected through Provider of Services related, parent or unit certification numbers.

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
25D1010732Jackson Hinds Comprehensive Health Center1655 Whiting Road, Jackson, MS 39209Provider-performed microscopyMar 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central Mississippi Civic46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Mavis Dawson Individual Corporate Director Apr 11, 2003
Jasmin O Chapman Individual Corporate OfficerChief Executive Officer Apr 11, 2003 100%
Ethel L Singleton Individual Corporate Director Apr 11, 2003
Connie a Jones Individual Corporate DirectorBoard of Director's President Jan 12, 2004
Lois C Christian Individual Corporate DirectorBoard Member Aug 21, 2006
John Wicks Individual Corporate Director Apr 17, 2023
Christopher Gray Individual Corporate Director Apr 17, 2023
Frances a Frazier Individual Corporate Director Apr 11, 2003
Lillie Ervin Individual Corporate Director Apr 11, 2003
Heraclio Aguilar Individual Corporate Director Apr 17, 2023
Larry D McMillian Individual Corporate Director Apr 11, 2003
Joanne Smith Individual W-2 Managing Employee Jun 7, 1999
Mary Thompson Individual Corporate Director Jul 18, 2022
Donna L Stamps Individual Corporate Director Apr 11, 2003
Alberta Johnson Individual Corporate Director Apr 11, 2003
John a Peoples Individual Corporate Director Apr 11, 2003

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Jackson-Hinds Comprehensive Health Center -School Based Health CenterJackson, MS, CCN 251029 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2012
Jackson-Hinds Comprehensive Health Center-Terry High School Based ClinTerry, MS, CCN 251028 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 1972
Gary Road Intermediate SchoolByram, MS, CCN 251056 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 May 1, 2017
May 1, 2017
Jackson-Hinds Comprehensive Health CenterRaymond, MS, CCN 251084 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 2019
Dec 1, 2012
Central Mississippi Civic Improvement Association, IncRaymond, MS, CCN 251086 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019

Practitioners & affiliated clinicians

Practitioners 1

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": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247097600000",
    "number": "1255360483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454",
            "telephone_number": "601-362-5321",
            "fax_number": "601-364-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 WHITING RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392095826",
            "telephone_number": "601-923-2547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2009-07-09",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "JASMIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-362-5321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "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": "05356512",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON HINDS COMPREHENSIVE HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.