Altheacare LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

ALTHEACARE LLC

Doing business as

Family Medical Clinic Vardaman

Practice address

310 W Sweet Potato St Ste B
Vardaman, MS 38878-8405

Phone

(662) 567-1282

NPI assigned

Oct 10, 2022

Last updated

Feb 9, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jana Earnest

Title

Office Manager

Phone

(662) 567-1283

Specialties & licenses 2

Addresses

Other names 1

• Family Medical Clinic Vardaman Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467177683. Details of each certification follow.

• CCN A53834 Rural health clinic · Active · Details

Rural health clinic certification: CCN A53834

Legal name

ALTHEACARE LLC

Doing business as

FAMILY MEDICAL CLINIC VARDAMAN

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

May 30, 2023

Last certification

May 30, 2023

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

310 W Sweet Potato St
Ste B
Vardaman, MS 38878

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Owners & managing parties with NPI records 1

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

• Amanda Brand Mahan, FNP-C

  • Nurse Practitioner
  • Houston, MS
  • NPI 1720562226

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

  CMS ownership

Practitioners 3

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.

• Joy S Chapman, NP

  • Nurse Practitioner
  • Okolona, MS
  • NPI 1427064344
  Medicare reassignment Care Compare group NPD
• Amanda Brand Mahan, FNP-C

  • Nurse Practitioner
  • Houston, MS
  • NPI 1720562226
  Medicare reassignment Care Compare group NPD
• James Micheal Orender, MD

  • Internal Medicine Physician
  • Florence, AL
  • NPI 1538263058

  MS

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675900800000",
    "number": "1467177683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207",
            "city": "VARDAMAN",
            "state": "MS",
            "postal_code": "388780207",
            "telephone_number": "662-567-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W SWEET POTATO ST STE B",
            "city": "VARDAMAN",
            "state": "MS",
            "postal_code": "388788405",
            "telephone_number": "662-567-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTHEACARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-10",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A",
        "authorized_official_last_name": "EARNEST",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-567-1283"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Clinic Vardaman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barry Dayton Criddle, R.PH.
• Freds Stores of Tennessee Inc (Freds Xpress 3926)
• Mary Anne Hendrix, CFNP
• William Eldon Hester, RPH
• Cheryll Angel Ray, RPH

• Rural Health Clinic/Center in Vardaman, MS
• Providers in Vardaman, MS by specialty
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.