NPIMap

Organization Active NPI

Central Mississippi Civic Improvement Association, Inc.

Doing business as Gary Road Elementary School

  • Federally Qualified Health Center (FQHC)
  • Byram, MS
National Provider Identifier
1467868372
Registry record updated Dec 22, 2017
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
Gary Road Elementary School
Practice address
7241 Gary Rd
Byram, MS 39272-8947
Phone
(601) 892-4053
NPI assigned
Jul 11, 2014
Last updated
Dec 22, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2017

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

Authorized official

Name
Dr. Jasmin Chapman, DDS
Title
Chief Executive Officer
Phone
(601) 364-5142

Specialties & licenses 1

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

Addresses

Primary practice location

7241 Gary Rd
Byram, MS 39272-8947

Mailing address

3502 W Northside Dr
Jackson, MS 39213-4454

Other names 1

  • Gary Road Elementary School Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140822001171 MS Part A Provider - Federally Qualified Health Center (FQHC) 4183533235 Practice locations: Byram, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467868372. Details of each certification follow.

Federally qualified health center certification: CCN 251026

Legal name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Doing business as
GARY ROAD ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 22, 2014
Last certification
Aug 22, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 6, 1970 in MS
Enrollment address
7241 Gary Rd
Byram, MS 39272-8947

National Provider Directory

National Provider Directory
Tax ID family
Central Mississippi Civic Imrovement Association46 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

Locations

7241 Gary Rd
Jackson, MS 39272
Phone (601) 373-1319

Ownership & related parties

All disclosed owners & managing parties 9

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 Officer Nov 5, 2002
Jasmin O Chapman Individual W-2 Managing EmployeeChief Executive Officer Jul 21, 2014 100%
Ethel L Singleton Individual Corporate Officer Mar 17, 1986
Connie a Jones Individual Corporate Officer Jan 12, 2004
Lois C Christian Individual Corporate Officer Aug 21, 2006
Frances a Frazier Individual Corporate Officer Nov 5, 2002
Larry D McMillian Individual Corporate Officer Apr 21, 1997
Alberta Johnson Individual Corporate Officer Jan 14, 2004
John a Peoples Individual Corporate Officer Mar 17, 1986

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

NPI Registry JSON

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513900800000",
    "number": "1467868372",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7241 GARY RD",
            "city": "BYRAM",
            "state": "MS",
            "postal_code": "392728947",
            "telephone_number": "601-892-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2017-12-22",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "JASMIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "601-364-5142",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "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": "Gary Road Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Byram, MS

Sources for this page

Verify at the official NPI Registry.