NPIMap

Organization Active NPI

Central Mississippi Civic Improvement Association, Inc

Doing business as Jackson Hinds Comprehensive Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
National Provider Identifier
1447448667
Registry record updated Jan 29, 2021
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
Practice address
2185 Fortune St
Jackson, MS 39204-2333
Phone
(601) 960-5354
Fax
(601) 360-2625
NPI assigned
Oct 12, 2007
Last updated
Jan 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Authorized official

Name
Dr. Jasmin R Chapman, DDSNPI 1811931363
Title
Ceo
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

2185 Fortune St
Jackson, MS 39204-2333

Mailing address

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

Other names 1

  • Jackson Hinds Comprehensive Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071121000485 MS Part A Provider - Federally Qualified Health Center (FQHC) 4183533235 Practice locations: Jackson, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447448667. Details of each certification follow.

Federally qualified health center certification: CCN 251969

Legal name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2008
Last certification
Jan 8, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Oct 6, 1970 in MS
Enrollment address
2185 Fortune St
Jackson, MS 39204-2333

National Provider Directory

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

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 15

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 Director Jul 1, 2006
Jasmin O Chapman Individual Corporate Director Jul 1, 2006
W-2 Managing Employee Jul 1, 2006
Ethel L Singleton Individual Corporate Director Jul 1, 2006
Connie a Jones Individual Corporate Director Jul 1, 2006
Lois C Christian Individual Corporate Director Jul 1, 2006
John Wicks Individual Corporate Director Apr 17, 2023
Christopher Gray Individual Corporate Director Apr 17, 2023
Frances a Frazier Individual Corporate Director Jul 1, 2006
Lillie Ervin Individual Corporate Director Jul 1, 2006
Heraclio Aguilar Individual Corporate Director Apr 17, 2023
Larry D McMillian Individual Corporate Director Jul 1, 2006
Mary Thompson Individual Corporate Director Jul 18, 2022
Donna L Stamps Individual Corporate Director Jul 1, 2006
Alberta Johnson Individual Corporate Director Jul 1, 2006
John a Peoples Individual Corporate Director Jul 1, 2006

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 1

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": "1192147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611878400000",
    "number": "1447448667",
    "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",
            "fax_number": "601-364-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2185 FORTUNE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392042333",
            "telephone_number": "601-960-5354",
            "fax_number": "601-360-2625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-12",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "JASMIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "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",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson Hinds Comprehensive Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.