NPIMap

Organization Active NPI

Winston Medical Clinic LLC

Doing business as Winston Medical Clinic Noxapater

  • Rural Health Clinic/Center
  • Noxapater, MS
National Provider Identifier
1588091714
Registry record updated Feb 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WINSTON MEDICAL CLINIC LLC
Doing business as
Winston Medical Clinic Noxapater
Practice address
90 East Main Street
Noxapater, MS 39346
Phone
(662) 724-4051
Fax
(662) 724-4054
NPI assigned
Oct 2, 2013
Last updated
Feb 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
WINSTON MEDICAL CLINIC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2017

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

Authorized official

Name
Debra J Fryery
Title
Director of Clinic Operations
Phone
(662) 446-1972

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

90 East Main Street
Noxapater, MS 39346

Mailing address

PO Box 470
Louisville, MS 39339-0470
Phone (662) 446-1972

Other names 1

  • Winston Medical Clinic Noxapater Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130827000842 MS Part B Supplier - Clinic/Group Practice 7214170968 Receives reassigned benefits from 12 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Noxapater, MS; Louisville, MS
O20140124001251 MS Part B Supplier - Clinic/Group Practice 7214170968 Receives reassigned benefits from 2 practitioners
Practice locations: Noxapater, MS
O20140425000049 MS Part A Provider - Rural Health Clinic 7214170968 Practice locations: Noxapater, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588091714. Details of each certification follow.

Rural health clinic certification: CCN 258594

Legal name
WINSTON MEDICAL CLINIC LLC
Doing business as
WINSTON MEDICAL CLINIC-NOXAPATER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 23, 2014
Last certification
Sep 23, 2021
Ownership / control type
2B
Organization structure
LLCNon-profit
Incorporated
Nov 6, 2012 in MS
Enrollment address
90 East Main Street
Winston Medical Clinic-Noxapater
Noxapater, MS 39346-2610
Related CCNs
250027

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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
25D2066732Winston Medical Clinic Noxapater90 E Main Street, Noxapater, MS 39346Certificate of waiverOct 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Winston Medical Clinic LLC3 organizations share this tax ID, including this one
Part of
Winston Medical Clinic LLC

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

90 E Main St
Noxapater, MS 39346
Phone (662) 446-1222

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Debbie Fryery Individual Corporate DirectorDirector of Clinic Operations Jul 10, 2015
Operational/Managerial ControlDirector of Clinic Operations Jul 10, 2015
Winston County Medical Foundation Organization, Louisville, MS Non-profit 5% Or Greater Direct Ownership Interest Nov 6, 2012 100%
Operational/Managerial Control Nov 6, 2012 100%
James Nester Individual Corporate DirectorCeo Aug 8, 2023 100%
W-2 Managing EmployeeCeo Aug 8, 2023 100%
Operational/Managerial ControlCeo Aug 8, 2023 100%

Owners & managing parties with NPI records 5

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

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

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": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486598400000",
    "number": "1588091714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 470",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393390470",
            "telephone_number": "662-446-1972",
            "fax_number": "662-446-1039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 EAST MAIN STREET",
            "city": "NOXAPATER",
            "state": "MS",
            "postal_code": "39346",
            "telephone_number": "662-724-4051",
            "fax_number": "662-724-4054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINSTON MEDICAL CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINSTON MEDICAL CLINIC LLC",
        "enumeration_date": "2013-10-02",
        "last_updated": "2017-02-09",
        "status": "A",
        "authorized_official_last_name": "FRYERY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR OF CLINIC OPERATIONS",
        "authorized_official_telephone_number": "662-446-1972"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winston Medical Clinic Noxapater",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Noxapater, MS

Sources for this page

Verify at the official NPI Registry.