NPIMap

Organization Active NPI

Family Clinic of New Albany

  • Rural Health Clinic/Center
  • New Albany, MS
National Provider Identifier
1609884733
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY CLINIC OF NEW ALBANY
Practice address
474 W Bankhead St
New Albany, MS 38652-3319
Phone
(662) 534-7777
Fax
(662) 534-3050
NPI assigned
Aug 4, 2006
Last updated
Sep 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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

Authorized official

Name
Ginger Cox
Title
Office Manager
Phone
(662) 534-7777

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

474 W Bankhead St
New Albany, MS 38652-3319

Mailing address

474 W Bankhead St
New Albany, MS 38652-3319
Phone (662) 534-7777

Other identifiers 1

IdentifierTypeStateIssuer
258954OtherFAMILY CLINIC OF NEW ALBA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060501000359 MS Part A Provider - Rural Health Clinic 0345250767 Practice locations: New Albany, MS
O20060905000564 MS Part B Supplier - Clinic/Group Practice 0345250767 Receives reassigned benefits from 4 practitioners
Practice locations: New Albany, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609884733. Details of each certification follow.

Rural health clinic certification: CCN 258954

Legal name
FAMILY CLINIC OF NEW ALBANY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 19, 2001
Last certification
Apr 26, 2022
Ownership / control type
1B
Most recent change of ownership
Jan 5, 2005 (1 total)
Organization structure
CorporationProprietary
Incorporated
Jan 4, 2005 in MS
Enrollment address
474 W Bankhead St
New Albany, MS 38652-3319

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
25D0981556Family Clinic of New Albany474 W Bankhead St, New Albany, MS 38652Certificate of waiverFeb 5, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Trent Clark Individual 5% Or Greater Direct Ownership Interest Jan 1, 2018 50%
Corporate Officer Jan 1, 2018 40%
Brittany N Clark Individual 5% Or Greater Direct Ownership Interest Jan 1, 2018
W-2 Managing Employee Jan 1, 2018 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568332800000",
    "number": "1609884733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 W BANKHEAD ST",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386523319",
            "telephone_number": "662-534-7777",
            "fax_number": "662-534-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 W BANKHEAD ST",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386523319",
            "telephone_number": "662-534-7777",
            "fax_number": "662-534-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CLINIC OF NEW ALBANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2019-09-13",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "GINGER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-534-7777"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY CLINIC OF NEW ALBA",
            "identifier": "258954",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Albany, MS

Sources for this page

Verify at the official NPI Registry.