NPIMap

Organization Active NPI

Gibbs Comprehensive Care, LLC

  • Community/Behavioral Health Agency
  • Bernice, LA
National Provider Identifier
1295201242
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
GIBBS COMPREHENSIVE CARE, LLC
Practice address
101 Reeves Street
Bernice, LA 71222
Phone
(601) 531-3200
Fax
(601) 531-3107
NPI assigned
Oct 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Authorized official

Name
Dr. Traci Lynn Gibbs, NPNPI 1104074210
Title
Owner
Phone
(601) 692-8997

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

101 Reeves Street
Bernice, LA 71222

Mailing address

PO Box 188
Toomsuba, MS 39364-0188
Phone (601) 531-3200

Other identifiers 2

IdentifierTypeStateIssuer
03673567MedicaidMS
2487949MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181218001904 LA Part B Supplier - Clinic/Group Practice 3476850694 Receives reassigned benefits from 2 practitioners
Practice locations: Bernice, LA

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Gibbs Comprehensive Care LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1295201242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "TOOMSUBA",
            "state": "MS",
            "postal_code": "393640188",
            "telephone_number": "601-531-3200",
            "fax_number": "601-531-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 REEVES STREET",
            "city": "BERNICE",
            "state": "LA",
            "postal_code": "71222",
            "telephone_number": "601-531-3200",
            "fax_number": "601-531-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBBS COMPREHENSIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-692-8997",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03673567",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2487949",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bernice, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.