NPIMap

Organization Active NPI

Central Mississippi Civic Improvement Association, Inc.

Doing business as Jackson-Hinds Comprehensive Health Center Edwards Site

  • Federally Qualified Health Center (FQHC)
  • Edwards, MS
National Provider Identifier
1346684826
Registry record updated Oct 2, 2013
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 Edwards Site
Practice address
100 South Magnolia Street
Edwards, MS 39066
Phone
(601) 362-5321
NPI assigned
Apr 26, 2013
Last updated
Oct 2, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2013

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
Chief Executive Officer
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

100 South Magnolia Street
Edwards, MS 39066

Mailing address

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

Other names 1

  • Jackson-Hinds Comprehensive Health Center Edwards Site Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000125 MS Part B Supplier - Clinic/Group Practice 4183533235 Receives reassigned benefits from 70 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MS; Vicksburg, MS; Utica, MS; Edwards, MS; Hazlehurst, MS
O20131230001420 MS Part A Provider - Federally Qualified Health Center (FQHC) 4183533235 Practice locations: Edwards, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346684826. Details of each certification follow.

Federally qualified health center certification: CCN 251019

Legal name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Doing business as
JACKSON-HINDS COMPREHENSIVE HEALTH CENTER EDWARDS SITE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 30, 2013
Last certification
Dec 30, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 6, 1970 in MS
Enrollment address
100 South Magnolia Street
Jackson-Hinds Comprehensive Health Center Edwards
Edwards, MS 39066-9534

Other NPIs on the same Medicare enrollment 14

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

View all 14

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
25D2059376Jackson-Hinds Comprehensive HLTH CNTR - Edwards100 Magnolia Street, Edwards, MS 39066Provider-performed microscopyMay 20, 2027

National Provider Directory

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

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 9

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 OfficerBoard Member Nov 5, 2002
Jasmin O Chapman Individual Corporate Officer Jun 1, 2013
W-2 Managing EmployeeCeo Jun 1, 2013 100%
Ethel L Singleton Individual Corporate OfficerBoard Member Mar 17, 1986
Connie a Jones Individual Corporate OfficerBoard Member Jan 12, 2004
Lois C Christian Individual Corporate OfficerBoard Member Aug 21, 2006
Frances a Frazier Individual Corporate OfficerBoard Member Nov 5, 2002
Larry D McMillian Individual Corporate OfficerBoard Member Apr 21, 1997
Alberta Johnson Individual Corporate OfficerBoard Member Jan 14, 2002
John a Peoples Individual Corporate OfficerBoard Member Mar 17, 1986

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 4

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": "1366934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1346684826",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SOUTH MAGNOLIA STREET",
            "city": "EDWARDS",
            "state": "MS",
            "postal_code": "39066",
            "telephone_number": "601-362-5321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC",
        "enumeration_date": "2013-04-26",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "JASMIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson-Hinds Comprehensive Health Center Edwards Site",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edwards, MS

Sources for this page

Verify at the official NPI Registry.