NPIMap

Organization Active NPI

G a Carmichael Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Canton, MS
National Provider Identifier
1649337577
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Practice address
529 Mace St
Canton, MS 39046
Phone
(601) 859-1028
Fax
(601) 859-8771
NPI assigned
Jan 2, 2007
Last updated
Jun 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Authorized official

Name
Dr. James L. Coleman Jr., ED.D.
Title
Ceo
Phone
(601) 859-5213

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Nurse Practitioner 363L00000X
Dentist 122300000X
Family Medicine Physician 207Q00000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

529 Mace St
Canton, MS 39046

Mailing address

PO Box 588
Canton, MS 39046-0588
Phone (601) 859-5213

Other identifiers 1

IdentifierTypeStateIssuer
09015904MedicaidMS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050816001055 MS Part B Supplier - Clinic/Group Practice 2567371032 Receives reassigned benefits from 24 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Belzoni, MS; Yazoo City, MS; Vaughan, MS; Greenwood, MS; Carthage, MS; Canton, MS; Bentonia, MS
O20101213000270 MS Part A Provider - Federally Qualified Health Center (FQHC) 2567371032 Practice locations: Canton, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649337577. Details of each certification follow.

Federally qualified health center certification: CCN 251888

Legal name
G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 29, 2002
Last certification
Jan 29, 2002
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1973 in MS
Enrollment address
529 Mace St
Canton, MS 39046-3319

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
M Y L Family Health Ctr26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Rosie Evan-Williams Individual Corporate Director Aug 30, 2017
William Edwards Individual Corporate DirectorCfo Dec 1, 2019
W-2 Managing EmployeeCfo Dec 1, 2019
James Coleman Individual Corporate OfficerCeo Jun 1, 2016
W-2 Managing EmployeeCeo Jun 1, 2016
Enrique Cecilio Diaz Individual Corporate Director Aug 30, 2017
Joseph Davis Individual Corporate DirectorCoo Jun 1, 2016
Phyllis Bell-Luckett Individual Corporate Director Aug 30, 2017
Gregory Moseley Individual Corporate Director Oct 1, 2010
Deloris Harris Individual Corporate Director Aug 30, 2017
Luis Montgomery Individual Corporate Director Aug 30, 2017
June Gibson Individual Corporate Director Aug 30, 2017
Charles Henderson Individual Corporate Director Aug 30, 2017
Arnel Devon Bolden Individual Corporate Director Aug 30, 2017
Veda Horton Individual Corporate Director Aug 30, 2017
Karl Sykes Individual Corporate Director Aug 30, 2017

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
G a Carmichael Family Health Center, Inc.Carthage, MS, CCN 251143 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 26, 2021
G a Carmichael Family Health Center, IncGreenwood, MS, CCN 251158 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 26, 2021

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1649337577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 588",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390460588",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 MACE ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "39046",
            "telephone_number": "601-859-1028",
            "fax_number": "601-859-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G A CARMICHAEL FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-859-5213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015904",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MS

Sources for this page

Verify at the official NPI Registry.