NPIMap

Organization Active NPI

City of Jackson Healthcare Authority

Doing business as Family Medical of Clinic of Jackson

  • Family Medicine Physician
  • Jackson, AL
National Provider Identifier
1366808404
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CITY OF JACKSON HEALTHCARE AUTHORITY
Doing business as
Family Medical of Clinic of Jackson
Practice address
227 Hospital Dr
Jackson, AL 36545-2423
Phone
(251) 246-4446
NPI assigned
Jan 5, 2016
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
JACKSON MEDICAL CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Suzie Murphy
Title
Administrator
Phone
(251) 246-4446

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

227 Hospital Dr
Jackson, AL 36545-2423

Mailing address

220 Hospital Dr
Jackson, AL 36545-2459
Phone (251) 246-9021

Other names 1

  • Family Medical of Clinic of Jackson Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20160224002285 AL Part B Supplier - Clinic/Group Practice 6800191107 Receives reassigned benefits from 4 practitioners
Practice locations: Jackson, AL
O20240823003408 AL Part A Provider - Rural Health Clinic 2062950199 Practice locations: Jackson, AL
O20250211002844 AL Part B Supplier - Clinic/Group Practice 2062950199 Receives reassigned benefits from 6 practitioners
Practice locations: Jackson, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366808404. Details of each certification follow.

Rural health clinic certification: CCN 013471

Legal name
CITY OF JACKSON HEALTHCARE AUTHORITY
Doing business as
FAMILY MEDICAL CLINIC OF JACKSON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 11, 2017
Last certification
May 1, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
227 Hospital Dr
Jackson, AL 36545-2423
Related CCNs
010128

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
City of Jackson Healthcare Authority3 organizations share this tax ID, including this one
Part of
Jackson Medical Center LLC

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

227 Hospital Dr
Jackson, AL 36545
Phone (251) 246-4446

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
City of Jackson Healthcare Authority Organization, Jackson, AL Management services company 5% Or Greater Direct Ownership Interest Sep 30, 2024 100%
Grady Bedwell Individual Corporate DirectorChairman, Board of Dir Sep 30, 2024 33.33%
Bobby G Brooks Individual Corporate DirectorVic Chairman, Board of Fir Oct 11, 2022 33.33%
Jennifer Ryland Individual W-2 Managing EmployeeAd; Sep 30, 2024 100%
Hassell C Bouncd Individual Corporate DirectorAssist Sec, Assist6 Treas, Dir Sep 30, 2024 33.33%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Jackson Medical Center Home HealthJackson, AL, CCN 017112 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 30, 2024
Sep 30, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 2

DateEventCounterparty
Sep 30, 2024 Change of OwnershipThis provider was the buyer Family Medical Clinic of JacksonCCN 013471, AL, NPI 1366808404
Sep 30, 2024 Change of OwnershipThis provider was the seller Family Medical Clinic of JacksonCCN 013471, AL, NPI 1366808404

Practitioners & affiliated clinicians

Practitioners 7

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": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1366808404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 HOSPITAL DR",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365452459",
            "telephone_number": "251-246-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 HOSPITAL DR",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365452423",
            "telephone_number": "251-246-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF JACKSON HEALTHCARE AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON MEDICAL CENTER LLC",
        "enumeration_date": "2016-01-05",
        "last_updated": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "SUZIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "251-246-4446"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical of Clinic of Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, AL

Sources for this page

Verify at the official NPI Registry.