NPIMap

Organization Active NPI

Northeast Mississippi Health Care, Inc.

Doing business as Mt. Pleasant Family Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Mt. Pleasant, MS
National Provider Identifier
1386792992
Registry record updated Nov 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST MISSISSIPPI HEALTH CARE, INC.
Doing business as
Mt. Pleasant Family Health Clinic
Practice address
154 Mt. Pleasant Road
Mt. Pleasant, MS 38649
Phone
(662) 851-7939
Fax
(662) 851-9053
NPI assigned
Jan 8, 2007
Last updated
Nov 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2010

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

Authorized official

Name
Mrs. Marjorie P. McKinney
Title
Executive Director
Phone
(662) 838-2163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

154 Mt. Pleasant Road
Mt. Pleasant, MS 38649

Mailing address

12 East Brunswick Ave.
P.O. Box 698
Byhalia, MS 38611
Phone (662) 851-7939

Other names 1

  • Mt. Pleasant Family Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040602001469 MS Part B Supplier - Clinic/Group Practice 5294717377 Receives reassigned benefits from 13 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Byhalia, MS; Mt Pleasant, MS; Southaven, MS
O20101201000541 MS Part A Provider - Federally Qualified Health Center (FQHC) 5294717377 Practice locations: Mt Pleasant, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386792992. Details of each certification follow.

Federally qualified health center certification: CCN 251848

Legal name
NORTHEAST MISSISSIPPI HEALTH CARE INC
Doing business as
MT. PLEASANT FAMILY HEALTH CLINC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 1995
Last certification
Apr 1, 1995
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 1979 in MS
Enrollment address
154 Old Mt Pleasant Rd
Mt Pleasant, MS 38635
Related CCNs
251817

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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
25D0884513Mt Pleasant Family Health Clinic154 Mt Pleasant Road, Mount Pleasant, MS 38649Certificate of waiverMar 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Northeast Ms Health Care Inc4 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.

Locations

154 Mount Pleasant Rd
Mt Pleasant, MS 38635
Phone (662) 851-7939

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HECABD

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Albert Lay Individual Corporate Director Dec 3, 2010
Adolphus Shipp Individual Corporate Director Dec 3, 2010
Lesley L Sigman Individual Corporate Director Dec 3, 2010
Terry H Sanderson Individual Corporate Director Dec 3, 2010
Annie M Jamison Individual Corporate Director Dec 3, 2010
William D Fitts Individual Corporate Director Dec 3, 2010
Janette W Jones Individual Corporate Director Dec 3, 2010
Felecia a Harvell Individual Corporate Director Dec 3, 2010
Lizzie J Blackmond Individual Corporate Director Dec 3, 2010
Bobby G Rice Individual Corporate Director Dec 3, 2010
Clifton Rodgers Individual 5% Or Greater Indirect Ownership Interest Oct 1, 2011
Corporate DirectorExecutive Director Oct 1, 2011
W-2 Managing Employee Oct 1, 2011

Owners & managing parties with NPI records 1

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

  • Clifton Rodgers, M.D.
    • Family Medicine Physician
    • Byhalia, MS
    • NPI 1861496507

    5% Or Greater Indirect Ownership Interest, Corporate Director, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 10

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": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289952000000",
    "number": "1386792992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 EAST BRUNSWICK AVE.",
            "address_2": "P.O. BOX 698",
            "city": "BYHALIA",
            "state": "MS",
            "postal_code": "38611",
            "telephone_number": "662-851-7939",
            "fax_number": "662-851-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 MT. PLEASANT ROAD",
            "city": "MT. PLEASANT",
            "state": "MS",
            "postal_code": "38649",
            "telephone_number": "662-851-7939",
            "fax_number": "662-851-9053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MISSISSIPPI HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2010-11-17",
        "status": "A",
        "authorized_official_last_name": "MCKINNEY",
        "authorized_official_first_name": "MARJORIE",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "662-838-2163",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Pleasant Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.