Central Mississippi Civic Improvement Association, Inc.
Organization Active NPI Community Health Worker · Jackson, MS
NPI 1659618106 · NPPES record last updated Jan 3, 2013
Key facts
- NPI
- 1659618106
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Worker 172V00000X
- Legal business name
- CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.
- Practice address
- 1860 Chadwick Dr
Jackson, MS 39204-3463 - Phone
- (601) 362-5321
- Fax
- (601) 364-5159
- NPI assigned
- Jan 3, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Jasmin Chapman
- Title
- Chief Executive Officer
- Phone
- (601) 362-5321
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 37
Practitioners 2
-
Shari R. Brown, FNP-BC
-
La'Tonya M Jones, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Federally qualified health center certification: CCN 251014
- Legal name
- CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
- Doing business as
- JACKSON-HINDS CENTRAL MISSISSIPPI MEDICAL CENTER SITE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 27, 2013
- Last certification
- Feb 27, 2013
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Oct 6, 1970 in MS
- Enrollment address
- 2649 Highway 80 W
# 301B
Jackson, MS 39204-2216
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Jasmin O Chapman |
Corporate Officer | Dec 1, 2012 | |
| W-2 Managing Employee | Dec 1, 2012 | ||
| Ethel L Singleton |
Corporate Officer | Dec 1, 2012 | |
| Connie a Jones |
Corporate Officer | Dec 1, 2012 | |
| Lois C Christian |
Corporate Officer | Dec 1, 2012 | |
| John Marshall Lusk |
Corporate Officer | Apr 17, 2023 | |
| John Wicks |
Corporate Officer | Apr 17, 2023 | |
| Christopher Gray |
Corporate Officer | Apr 17, 2023 | |
| Frances a Frazier |
Corporate Officer | Dec 1, 2012 | |
| Lillie Ervin |
Corporate Officer | Aug 19, 1985 | |
| Heraclio Aguilar |
Corporate Officer | Apr 17, 2023 | |
| Larry D McMillian |
Corporate Officer | Apr 21, 1997 | |
| Mary Thompson |
Corporate Officer | Jul 18, 2022 | |
| Alberta Johnson |
Corporate Officer | Dec 1, 2012 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Jackson-Hinds Comprehensive Health Center -School Based Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 1, 2012 |
| Jackson-Hinds Comprehensive Health Center-Terry High School Based Clin |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Oct 1, 1972 |
| Gary Road Intermediate School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
May 1, 2017 May 1, 2017 |
| Jackson-Hinds Comprehensive Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jan 1, 2019 Dec 1, 2012 |
| Central Mississippi Civic Improvement Association, Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040128000125 | MS | Part B Supplier - Clinic/Group Practice | 4183533235 |
Receives reassigned benefits from 70 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jackson, MS; Vicksburg, MS; Utica, MS; Edwards, MS; Hazlehurst, MS |
| O20130306000159 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 4183533235 | Practice locations: Jackson, MS |
National Provider Directory
- Tax ID family
- Central Mississippi Improvement Association
Locations
2649 Highway 80 W
Ste 301B
Jackson, MS 39204
Phone (601) 376-2999
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker |
172V00000X | Yes |
Addresses
Primary practice location
1860 Chadwick Dr
Jackson, MS 39204-3463
Mailing address
3502 W Northside Dr
Jackson, MS 39213-4454
Other names
- Jackson-Hinds Central Mississippi Medical Center Site
Other providers in Jackson, MS
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Health Services, Inc
All providers in Jackson, MS · Community Health Worker in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.