NPIMap

Organization Active NPI

Olive Branch Family Medical Center

  • Family Medicine Physician
  • Olive Branch, MS
National Provider Identifier
1629018478
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OLIVE BRANCH FAMILY MEDICAL CENTER
Practice address
9075 Sandidge Center CV
Olive Branch, MS 38654-3514
Phone
(662) 895-4949
Fax
(662) 895-6776
NPI assigned
Jun 8, 2006
Last updated
Dec 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Authorized official

Name
Amy Green
Title
Business Office Manager
Phone
(662) 893-8484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MS Primary

Addresses

Primary practice location

9075 Sandidge Center CV
Olive Branch, MS 38654-3514

Mailing address

9075 Sandidge Center CV
Olive Branch, MS 38654-3514
Phone (662) 895-4949

Other practice location 1

8135 Goodman Rd
Olive Branch, MS 38654-2103
Phone (662) 895-4949

Other identifiers 1

IdentifierTypeStateIssuer
1629018478OtherNPI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rhuling@direct.obfmc.nextgenshare.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040313000211 MS Part B Supplier - Clinic/Group Practice 2567351984 Receives reassigned benefits from 19 practitioners
Practice locations: Olive Branch, MS

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
25D0927270Olive Branch Family Medical Center9075 Sandidge Center Cove, Olive Branch, MS 38654ComplianceJun 11, 2028

National Provider Directory

National Provider Directory

Locations

9075 Sandidge Center Cv
Olive Branch, MS 38654
Phone (662) 895-4949

Interoperability endpoints

  • Direct secure messaging: rhuling@direct.obfmc.nextgenshare.com

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1629018478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9075 SANDIDGE CENTER CV",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543514",
            "telephone_number": "662-895-4949",
            "fax_number": "662-895-6776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9075 SANDIDGE CENTER CV",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386543514",
            "telephone_number": "662-895-4949",
            "fax_number": "662-895-6776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8135 Goodman Rd",
            "address_purpose": "LOCATION",
            "city": "Olive Branch",
            "state": "MS",
            "postal_code": "386542103",
            "country_code": "US",
            "telephone_number": "662-895-4949",
            "fax_number": "662-893-1103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OLIVE BRANCH FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "662-893-8484"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1629018478",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rhuling@direct.obfmc.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9075 Sandidge Center Cv",
            "city": "Olive Branch",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386543514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.