NPIMap

Organization Active NPI

East Central Mississippi Health Care Inc

Doing business as Sebastopol Clinic

  • Federally Qualified Health Center (FQHC)
  • Sebastopol, MS
National Provider Identifier
1699721209
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST CENTRAL MISSISSIPPI HEALTH CARE INC
Doing business as
Sebastopol Clinic
Practice address
1488 Hwy 487
Sebastopol, MS 39359
Phone
(601) 625-7140
Fax
(601) 625-7199
NPI assigned
May 25, 2006
Last updated
Apr 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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

Authorized official

Name
Mrs. Jill Bishop
Title
Ceo
Phone
(601) 625-7140

Specialties & licenses 1

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

Addresses

Primary practice location

1488 Hwy 487
Sebastopol, MS 39359

Mailing address

PO Box 142
Sebastopol, MS 39359
Phone (601) 625-7140

Other identifiers 2

IdentifierTypeStateIssuer
09010024MedicaidMS
DA1146OtherRAILROAD MEDICARE

Other names 1

  • Sebastopol Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040129000363 MS Part B Supplier - Clinic/Group Practice 0941103717 Receives reassigned benefits from 17 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sebastopol, MS; Walnut Grove, MS; Philadelphia, MS; Newton, MS
O20100629000466 MS Part A Provider - Federally Qualified Health Center (FQHC) 0941103717 Practice locations: Sebastopol, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699721209. Details of each certification follow.

Federally qualified health center certification: CCN 251829

Legal name
EAST CENTRAL MISSISSIPPI HEALTH CARE INC
Doing business as
SEBASTOPOL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 4, 1978 in MS
Enrollment address
1488 Hwy 487
Sebastopol, MS 39359-0150

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
East CTRL Ms HLTH Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

199 Rimmer St
Walnut Grove, MS 39189
Phone (601) 253-2733

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Eric Adcock Individual Corporate Officer Apr 1, 2019
Georgia L Jones Individual Corporate Officer Feb 1, 2022
Margie Hughes Individual Corporate Officer Apr 1, 2019
Bobbie Sanders Individual Corporate Officer Nov 1, 2008
Justin McDill Individual Corporate Officer Oct 17, 2022
Delia Shepard Individual Corporate Officer May 1, 2008
Denise Hawkins Individual Corporate Officer Feb 1, 2011
Tammy Hunter Individual Corporate Officer Apr 1, 2019
Steve Duett Individual Corporate Officer Jun 1, 1999
Jill Bishop Individual Corporate DirectorCeo Apr 1, 2004 100%
W-2 Managing EmployeeCeo Apr 1, 2004 100%
Johnny Barnes Individual Corporate Officer Sep 16, 2013
Regina Gardner Individual Corporate Officer Apr 1, 2002
Tammy Plaisance Individual Operational/Managerial Control Jul 26, 2024

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
East Central Mississippi Health Care IncNewton, MS, CCN 251031 Federally qualified health center Operational/Managerial Control (100%) Aug 20, 2015

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1699721209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 142",
            "city": "SEBASTOPOL",
            "state": "MS",
            "postal_code": "39359",
            "telephone_number": "601-625-7140",
            "fax_number": "601-625-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1488 HWY 487",
            "city": "SEBASTOPOL",
            "state": "MS",
            "postal_code": "39359",
            "telephone_number": "601-625-7140",
            "fax_number": "601-625-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL MISSISSIPPI HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-625-7140",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09010024",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA1146",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sebastopol Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sebastopol, MS

Sources for this page

Verify at the official NPI Registry.