NPIMap

Organization Active NPI

Greater Meridian Health Clinic, Inc.

Doing business as Oktibbeha Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Starkville, MS
National Provider Identifier
1396842027
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER MERIDIAN HEALTH CLINIC, INC.
Doing business as
Oktibbeha Family Medical Center
Practice address
511 Academy Rd
Starkville, MS 39759-4021
Phone
(662) 323-2911
Fax
(844) 778-8922
NPI assigned
Sep 16, 2006
Last updated
May 16, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GREATER MERIDIAN HEALTH CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Wilbert L. Jones
Title
Ceo
Phone
(601) 693-0118

Specialties & licenses 1

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

Addresses

Primary practice location

511 Academy Rd
Starkville, MS 39759-4021

Mailing address

2701 Davis St
Meridian, MS 39301-5708
Phone (601) 693-0118

Other identifiers 1

IdentifierTypeStateIssuer
001389094MedicaidMS

Other names 1

  • Oktibbeha Family Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030716000022 MS Part A Provider - Federally Qualified Health Center (FQHC) 9032027834 Practice locations: Starkville, MS
O20040217000471 MS Part B Supplier - Clinic/Group Practice 9032027834 Receives reassigned benefits from 16 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Meridian, MS; Starkville, MS; Scooba, MS; Macon, MS; Louisville, MS; Dekalb, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396842027. Details of each certification follow.

Federally qualified health center certification: CCN 251919

Legal name
GREATER MERIDIAN HEALTH CLINIC, INC.
Doing business as
OKTIBBEHA FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 6, 2003
Last certification
Oct 6, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 7, 2003 in MS
Enrollment address
511 Academy Rd
Starkville, MS 39759-4021

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Greater Meridian HLTH C11 organizations share this tax ID, including this one
Part of
Greater Meridian HLTH C

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Ralph Henson Individual Corporate DirectorBoard of Director Jan 1, 2023
Gwendolyn Hughes Individual Operational/Managerial ControlBoard Member Jan 1, 2019
Tonya M Hunt Individual Operational/Managerial ControlBoard Member Jan 3, 2012
Deborah Todd Individual Operational/Managerial ControlBoard Member Oct 30, 1986
Jennifer Gentry Individual Corporate DirectorBoard of Director Jan 1, 2023
Latoria Brown Individual Corporate DirectorBoard Member Jan 1, 2022
Jimmie Smith Individual Operational/Managerial ControlBoard President Mar 30, 1989
Michelle Stewart Individual Corporate OfficerCfo Jul 1, 2014
Derron Radcliff Individual Corporate DirectorBoard of Director Jan 1, 2026
Wilbert L. Jones Individual Corporate DirectorCeo Jan 7, 1980
Lisa Silliman Individual Corporate DirectorBoard Member Jan 1, 2022
Trevelle McGlothin Individual Corporate DirectorBoard of Director Jan 1, 2026
Melvin R Robinson Individual Operational/Managerial ControlBoard Member Mar 26, 1998
Laura Carmichael Individual Corporate DirectorBoard Member Jan 1, 2022
Dede Mogollon Individual Operational/Managerial ControlBoard Member Jan 1, 2019
Greater Meridian Health Clinic, Inc. Organization, Meridian, MS Corporation, Non-profit Operational/Managerial Control Oct 6, 2003

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Shuqualak-Noxubee Health ClinicMacon, MS, CCN 251834 Federally qualified health center Operational/Managerial Control Aug 1, 1987
GMHC, Inc./MPSD West End/T J Harris Community School Base ClinicMeridian, MS, CCN 251069 Federally qualified health center Operational/Managerial Control Nov 16, 2017
GMHC, Inc./MPSD Meridian High School Community School Based ClinicMeridian, MS, CCN 251090 Federally qualified health center Operational/Managerial Control May 1, 2019
Greater Meridian Health Clinic, Inc.Meridian, MS, CCN 251137 Federally qualified health center Operational/Managerial Control Oct 1, 1986

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

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": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1396842027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 DAVIS ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393015708",
            "telephone_number": "601-693-0118",
            "fax_number": "601-965-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 ACADEMY RD",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397594021",
            "telephone_number": "662-323-2911",
            "fax_number": "844-778-8922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER MERIDIAN HEALTH CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREATER MERIDIAN HEALTH CLINIC, INC.",
        "enumeration_date": "2006-09-16",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "WILBERT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-693-0118"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001389094",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oktibbeha Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oktibbeha Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Starkville, MS

Sources for this page

Verify at the official NPI Registry.