NPIMap

Organization Active NPI

Central Mississippi Civic Improvement Association, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
National Provider Identifier
1689047201
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC
Practice address
386 Raymond Rd
Jackson, MS 39204-3700
Phone
(601) 364-5142
NPI assigned
Nov 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Authorized official

Name
Jasmin Chapman, DDS
Title
Chief Executive Officer
Phone
(601) 364-5142

Specialties & licenses 1

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

Addresses

Primary practice location

386 Raymond Rd
Jackson, MS 39204-3700

Mailing address

3502 W Northside Dr
Jackson, MS 39213-4454

Other names 1

  • The Village Apartment Complex Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Federally qualified health center certification: CCN 251037

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
THE VILLAGE APARTMENT COMPLEX
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2016
Last certification
Feb 5, 2016
Ownership / control type
For profit – corporation
Facility address
386 Raymond Road
Jackson, MS 39204

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1689047201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 RAYMOND RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043700",
            "telephone_number": "601-364-5142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-04",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "JASMIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "601-364-5142",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Village Apartment Complex",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.