Southeast Mississippi Rural Health Initiative, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.

Practice address

401 Dogwood Street
Collins, MS 39428-0000

Phone

(601) 765-4383

Fax

(601) 450-2493

NPI assigned

Sep 7, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Kaye Ray, CEO

Title

Cheif Executive Officer

Phone

(601) 545-8700

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Collins Elementary School Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 251048

Legal name

COLLINS ELEMENTARY SCHOOL

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 30, 2017

Last certification

May 30, 2017

Ownership / control type

For profit – corporation

Facility address

401 Dogwood Street
Collins, MS 39428

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662076800000",
    "number": "1497202527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-8700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 DOGWOOD STREET",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394280000",
            "telephone_number": "601-765-4383",
            "fax_number": "601-450-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "KAYE",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "601-545-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS MEDICARE PTAN",
            "identifier": "251048",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09405885",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collins Elementary School",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Collins Elementary School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kyle Robert Shepherd, HIS
• James Harold Shivers II, FNP
• Harpreet Singh Sood, MD
• Southeast Mississippi Rural Health Initiative, Inc.
• Southeast Mississippi Rural Health Initiative, Inc.
• Southeast Mississippi Rural Health Initiative, Inc.
• Southern Bone & Joint Specialists, PA
• Southern Family Medicine
• Lacie Speed
• Felicia Taylor, LPNII

• Federally Qualified Health Center (FQHC) in Collins, MS
• Providers in Collins, MS by specialty
• Federally Qualified Health Center (FQHC) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.