NPIMap

Organization Active NPI

My Brother'S Keeper, Inc

  • Clinic/Center
  • Jackson, MS
National Provider Identifier
1609128339
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MY BROTHER'S KEEPER, INC
Practice address
805 E River PL
Jackson, MS 39202-3486
Phone
(601) 500-7660
Fax
(769) 243-7946
NPI assigned
Oct 4, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Authorized official

Name
June A Gipson
Title
Ceo
Phone
(769) 216-2455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

805 E River PL
Jackson, MS 39202-3486

Mailing address

805 E River PL
Jackson, MS 39202-3486
Phone (601) 500-7660

Other practice location 1

500 E Woodrow Wilson Ave Ste M
Jackson, MS 39216-4538
Phone (601) 500-7660

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130322000283 MS Part B Supplier - Clinic/Group Practice 4082859004 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
Practice locations: Gulfport, MS; Hattiesburg, MS; Jackson, MS

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

805 E River Pl
Ste M
Jackson, MS 39202
Phone (601) 500-7660

805 E River Pl
Jackson, MS 39202
Phone (601) 364-2600

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1609128339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 E RIVER PL",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392023486",
            "telephone_number": "601-500-7660",
            "fax_number": "769-243-7946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 E RIVER PL",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392023486",
            "telephone_number": "601-500-7660",
            "fax_number": "769-243-7946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 E Woodrow Wilson Ave Ste M",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164538",
            "country_code": "US",
            "telephone_number": "601-500-7660",
            "fax_number": "601-957-3640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MY BROTHER'S KEEPER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-04",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "GIPSON",
        "authorized_official_first_name": "JUNE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "769-216-2455"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

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

Verify at the official NPI Registry.