NPIMap

Organization Active NPI

Family Health Center, Inc

Doing business as Sandersville Clinic

  • Community Health Worker
  • Sandersville, MS
National Provider Identifier
1578744900
Registry record updated Nov 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Legal business name
FAMILY HEALTH CENTER, INC
Doing business as
Sandersville Clinic
Practice address
203 Broad Street
Sandersville, MS 39477-0279
Phone
(601) 428-9918
Fax
(601) 649-5575
NPI assigned
Nov 14, 2007
Last updated
Nov 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2010

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

Authorized official

Name
Mr. Rashad N. Ali, MD, JD, FACOGNPI 1649297201
Title
Executive Director
Phone
(601) 425-3033

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
Community Health Worker 172V00000X MS Primary

Addresses

Primary practice location

203 Broad Street
Sandersville, MS 39477-0279

Mailing address

P.O. Box 4361
Laurel, MS 39441-4361
Phone (601) 425-3033

Other identifiers 2

IdentifierTypeStateIssuer
09015884MedicaidMS
9015884MedicaidMS

Other names 1

  • Sandersville Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040414000267 MS Part B Supplier - Clinic/Group Practice 9638163348 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurel, MS; Sandersville, MS; Taylorsville, MS; Waynesboro, MS
O20081125000774 MS Part A Provider - Federally Qualified Health Center (FQHC) 9638163348 Practice locations: Sandersville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578744900. Details of each certification follow.

Federally qualified health center certification: CCN 251899

Legal name
FAMILY HEALTH CENTER, INC
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1986 in MS
Enrollment address
203 Broad Street
Sandersville, MS 39477

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2031994Family Health Center Inc203 Broad Street, Sandersville, MS 39477Provider-performed microscopyNov 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Family Health Center10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

117 S 11th Ave
Laurel, MS 39440
Phone (601) 425-3033

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
George Barnes Individual Corporate Director Dec 3, 2008
Kathryn Mizell Individual Corporate Director Dec 3, 2008
Randy Laird Individual Corporate Director Dec 3, 2008
Sherrin Roberts Individual Corporate OfficerCfo Apr 1, 2012
W-2 Managing EmployeeCfo Apr 1, 2012
Barbara Pruitt Individual Corporate Director Dec 3, 2008
Coney Lee Johnson Individual Corporate OfficerChief Operating Officer Apr 1, 2012
W-2 Managing EmployeeChief Operating Officer Apr 1, 2012
Rashad N Ali Individual Corporate OfficerCeo Aug 1, 2006
W-2 Managing Employee Aug 1, 2006
Joan Young Individual Corporate Director Dec 3, 2008
Trina Heidelberg Individual Corporate Director Dec 3, 2008
Lee Farmer Individual Corporate Director Dec 3, 2008

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Health Center, Inc.Waynesboro, MS, CCN 251067 Federally qualified health center Other Aug 16, 1986

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

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": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1578744900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4361",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394414361",
            "telephone_number": "601-425-3033",
            "fax_number": "601-422-0431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 BROAD STREET",
            "city": "SANDERSVILLE",
            "state": "MS",
            "postal_code": "394770279",
            "telephone_number": "601-428-9918",
            "fax_number": "601-649-5575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "RASHAD",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-425-3033",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD, JD, FACOG"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015884",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9015884",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandersville Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandersville, MS

Sources for this page

Verify at the official NPI Registry.