NPIMap

Organization Active NPI

Central Mississippi Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
National Provider Identifier
1356483283
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC.
Practice address
5429 Robinson Road Ext
Jackson, MS 39204-4138
Phone
(601) 948-5572
Fax
(601) 353-7070
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Terry Johnson
Title
Human Resources Manager
Phone
(601) 948-5572

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5429 Robinson Road Ext
Jackson, MS 39204-4138

Mailing address

1134 Winter St
Jackson, MS 39204-2841
Phone (601) 948-5572

Other identifiers 1

IdentifierTypeStateIssuer
08582355MedicaidMS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040225000632 MS Part B Supplier - Clinic/Group Practice 2961398029 Receives reassigned benefits from 24 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MS; Tougaloo, MS
O20100823000108 MS Part A Provider - Federally Qualified Health Center (FQHC) 2961398029 Practice locations: Jackson, MS

Federally qualified health center certification: CCN 251936

Legal name
CENTRAL MISSISSIPPI HEALTH SERVICES, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 11, 2004
Last certification
Apr 11, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 7, 1981 in MS
Enrollment address
5429 Robinson Road Ext
Jackson, MS 39204-4138

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 4

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

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
25D1026903Central Mississippi Health Services5429 Robinson Rd, Jackson, MS 39204Provider-performed microscopyJun 14, 2028

National Provider Directory

National Provider Directory

Locations

1134 Winter St
Jackson, MS 39204
Phone (601) 948-5572

5429 Robinson Road Ext
Jackson, MS 39204
Phone (601) 914-0163

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
Obie M McNair Individual Corporate OfficerMedical Director Jul 1, 1991
Corporate Director May 18, 2004
W-2 Managing Employee Jul 1, 1991
Larry Johnson Individual Corporate Director Apr 20, 2004
Robert Smith Individual Corporate OfficerChief Executive Officer Dec 7, 1981
W-2 Managing EmployeeChief Executive Officer Feb 16, 2015
Florence Anthony Individual Corporate Director Apr 23, 2013
Alyce Clarke Individual Corporate Director Aug 17, 2004
Peggy Johnson Individual Corporate Director Sep 17, 2001
Judith Barber Individual Corporate Director Nov 17, 2009
Bobby Shumpert Individual Corporate Director Apr 23, 2013
Marvel a Turner Individual Corporate Director Aug 22, 2000

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1356483283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 WINTER ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392042841",
            "telephone_number": "601-948-5572",
            "fax_number": "601-353-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5429 ROBINSON ROAD EXT",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392044138",
            "telephone_number": "601-948-5572",
            "fax_number": "601-353-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "HUMAN RESOURCES MANAGER",
        "authorized_official_telephone_number": "601-948-5572"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08582355",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.