Central Mississippi Civic Improvement Association, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Jackson, MS
NPI 1497523153 · NPPES record last updated Feb 7, 2024
Key facts
- NPI
- 1497523153
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
- Practice address
- 1311 W Pearl St
Jackson, MS 39203-2841 - Phone
- (601) 362-5321
- NPI assigned
- Dec 12, 2023
- Organization subpart
- No
Authorized official
- Name
- Jasmin Chapman
- Title
- Ceo
- Phone
- (601) 362-5321
Corporate family (same tax ID) 37
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Federally qualified health center certification: CCN 251162
- Legal name
- CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
- Doing business as
- JACKSON-HINDS COMPREHENSIVE HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 16, 2023
- Last certification
- Feb 16, 2023
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1970 in MS
- Enrollment address
- 1311 W Pearl St
Jackson, MS 39203-2841
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Jasmin O Chapman |
Corporate Officer | Dec 28, 1998 | |
| W-2 Managing Employee | Dec 28, 1998 | ||
| Ethel L Singleton |
Corporate Director | Mar 17, 1986 | |
| Connie a Jones |
Corporate Director | Jan 12, 2004 | |
| Lois C Christian |
Corporate Director | Aug 21, 2006 | |
| John Wicks |
Corporate Director | Apr 17, 2023 | |
| Christopher Gray |
Corporate Director | Apr 17, 2023 | |
| Frances a Frazier |
Corporate Director | Nov 5, 2002 | |
| Lillie Ervin |
Corporate Director | Aug 19, 1985 | |
| Heraclio Aguilar |
Corporate Director | Apr 17, 2023 | |
| Larry D McMillian |
Corporate Director | Apr 21, 1997 | |
| Mary Thompson |
Corporate Director | Jul 18, 2022 | |
| Alberta Johnson |
Corporate Director | Jan 14, 2002 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Jackson-Hinds Comprehensive Health Center -School Based Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 1, 2012 |
| Jackson-Hinds Comprehensive Health Center-Terry High School Based Clin |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Oct 1, 1972 |
| Gary Road Intermediate School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
May 1, 2017 May 1, 2017 |
| Jackson-Hinds Comprehensive Health Center |
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, Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240221003817 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 4183533235 | Practice locations: Jackson, MS |
National Provider Directory
- Tax ID family
- Central Mississippi Improvement Association
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1311 W Pearl St
Jackson, MS 39203-2841
Mailing address
3502 W Northside Dr
Jackson, MS 39213-4454
Other names
- Jackson-Hinds Comprehensive Health Center
Other providers in Jackson, MS
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
- Central Mississippi Civic Improvement Association, Inc
All providers in Jackson, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.