Yalobusha Medical Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

R872547 Issued in MS

Legal business name

YALOBUSHA MEDICAL CLINIC, LLC

Practice address

712 S Main St
Water Valley, MS 38965-3334

Phone

(662) 473-1140

Fax

(662) 473-1138

NPI assigned

Jul 8, 2012

Last updated

Apr 5, 2022By 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

Cinnamon Foster, FNP-BCNPI 1659607232

Title

Sole Member

Phone

(662) 473-1140

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17185/brand/1/csg/1/fhir/r4

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.

• Cinnamon Caryl Foster, MSN, FNP-BC

  • Family Nurse Practitioner
  • Water Valley, MS
  • NPI 1659607232
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1341705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1295090009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 S MAIN ST",
            "city": "WATER VALLEY",
            "state": "MS",
            "postal_code": "389653334",
            "telephone_number": "662-473-1140",
            "fax_number": "662-473-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 S MAIN ST",
            "city": "WATER VALLEY",
            "state": "MS",
            "postal_code": "389653334",
            "telephone_number": "662-473-1140",
            "fax_number": "662-473-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YALOBUSHA MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-08",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "CINNAMON",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "662-473-1140",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "R872547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI, TYPE 1",
            "identifier": "1659607232",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yalobusha General Hospital (Yalobusha General Hospital Prof Fee)
• Yalobusha General Hospital (Yalobusha County Ambulance)
• Yalobusha General Hospital
• Yalobusha General Hospital
• Yalobusha General Hospital DME

• Primary Care Clinic/Center in Water Valley, MS
• Providers in Water Valley, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.