NPIMap

Organization Active NPI

Independent Healthcare Management, Inc

Doing business as Forest Family Practice

  • Rural Health Clinic/Center
  • Forest, MS
National Provider Identifier
1649761685
Registry record updated May 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
INDEPENDENT HEALTHCARE MANAGEMENT, INC
Doing business as
Forest Family Practice
Practice address
1 Medical LN Ste B
Forest, MS 39074-4039
Phone
(601) 469-4861
NPI assigned
May 25, 2018
Last updated
May 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2020

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

Authorized official

Name
John P Lee, MDNPI 1992806699
Title
Cob
Phone
(601) 469-4861

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1 Medical LN Ste B
Forest, MS 39074-4039

Mailing address

100 Pioneer Way
Magee, MS 39111-5501
Phone (601) 849-6440

Other practice location 1

1 Medical Ln
Forest, MS 39074-4039
Phone (601) 469-4861

Other names 1

  • Forest Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031215000487 MS Part B Supplier - Clinic/Group Practice 0840197232 Receives reassigned benefits from 95 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, MS; Newton, MS; Morton, MS; Magee, MS; Forest, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649761685. Details of each certification follow.

Rural health clinic certification: CCN 258582

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FOREST FAMILY PRACTICE ( CLOSED )
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 11, 2019
Last certification
Aug 9, 2022
Ownership / control type
2B
Facility address
1 Medical Lane, Suite B
Forest, MS 39074
Related CCNs
251300

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Member of 1

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

Locations

1 Medical Ln
Forest, MS 39074
Phone (601) 469-4681

Practitioners & affiliated clinicians

Practitioners 2

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": "1527206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590451200000",
    "number": "1649761685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PIONEER WAY",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391115501",
            "telephone_number": "601-849-6440",
            "fax_number": "600-849-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL LN STE B",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390744039",
            "telephone_number": "601-469-4861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Ln",
            "address_purpose": "LOCATION",
            "city": "Forest",
            "state": "MS",
            "postal_code": "390744039",
            "country_code": "US",
            "telephone_number": "601-469-4861",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDEPENDENT HEALTHCARE MANAGEMENT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-25",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "COB",
        "authorized_official_telephone_number": "601-469-4861",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forest Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest, MS

Sources for this page

Verify at the official NPI Registry.