NPIMap

Organization Active NPI

G a Carmichael Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Greenwood, MS
National Provider Identifier
1679298939
Registry record updated Oct 10, 2022
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
200 Grand Blvd
Greenwood, MS 38930-3504
Phone
(601) 859-5213
Fax
(601) 859-8771
NPI assigned
Oct 10, 2022
Last updated
Oct 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

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

Authorized official

Name
Joseph Davis
Title
Coo
Phone
(601) 859-5213

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

200 Grand Blvd
Greenwood, MS 38930-3504

Mailing address

1668 W Peace St
Canton, MS 39046-5332
Phone (601) 859-5213

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address billinggac@gacfhc.org Direct

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
O20240203000243 MS Part A Provider - Federally Qualified Health Center (FQHC) 2567371032 Practice locations: Greenwood, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679298939. Details of each certification follow.

Federally qualified health center certification: CCN 251158

Legal name
G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Doing business as
G A CARMICHAEL FAMILY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 12, 2024
Last certification
Jan 12, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
200 Grand Blvd
Greenwood, MS 38930-3504

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

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
25D2292310Ga Carmichael Family Health Center200 Grand Blvd, Greenwood, MS 38930Certificate of waiverOct 23, 2027

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

Locations

1547 Jerry Clower Blvd
Yazoo City, MS 39194
Phone (662) 746-6531

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
William Edwards Individual Operational/Managerial Control Dec 1, 2019
OtherCfo Dec 1, 2019
G a Carmichael Family Health Center, Inc. Organization, Canton, MS Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 26, 2021
James Coleman Individual Corporate Officer Jan 1, 2016
Corporate Director Jan 1, 2016
OtherCeo Jan 1, 2016
Joseph Davis Individual Corporate Director Jan 1, 2016
OtherCoo Jan 1, 2016

Owners & managing parties with NPI records 15

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

View all 15

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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": "1665360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665360000000",
    "number": "1679298939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1668 W PEACE ST",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390465332",
            "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": "200 GRAND BLVD",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389303504",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G A CARMICHAEL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "601-859-5213"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "billinggac@gacfhc.org",
            "affiliation": "N",
            "endpointDescription": "Billing Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Mailing Address",
            "address_1": "200 Grand Blvd",
            "city": "Greenwood",
            "state": "MS",
            "country_code": "US",
            "postal_code": "389303504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenwood, MS

Sources for this page

Verify at the official NPI Registry.