NPIMap

Organization Active NPI

Hernando Family Medical Clinic, LLC

Doing business as Sluder Medical Clinic, LLC

  • Family Nurse Practitioner
  • Senatobia, MS
National Provider Identifier
1740350628
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
HERNANDO FAMILY MEDICAL CLINIC, LLC
Doing business as
Sluder Medical Clinic, LLC
Practice address
2778 Highway 51 S
Senatobia, MS 38668-9403
Phone
(662) 429-4988
Fax
(662) 429-4966
NPI assigned
Nov 8, 2006
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Lisa Wynn
Title
Billing Manager
Phone
(662) 429-4988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X MS Primary

Addresses

Primary practice location

2778 Highway 51 S
Senatobia, MS 38668-9403

Mailing address

2778 Highway 51 S
Senatobia, MS 38668-9403
Phone (662) 429-4988

Other identifiers 1

IdentifierTypeStateIssuer
000735805MedicaidMS

Other names 1

  • SLUDER MEDICAL CLINIC, LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061218000575 MS Part B Supplier - Clinic/Group Practice 9931107018 Receives reassigned benefits from 3 practitioners
Practice locations: Senatobia, MS

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
25D1062486Sluder Medical Clinic2778 Highway 51 South, Senatobia, MS 38668ComplianceMar 16, 2027

National Provider Directory

National Provider Directory

Locations

2670 McIngvale Rd
Ste H
Hernando, MS 38632
Phone (662) 429-4988

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22832/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1740350628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2778 HIGHWAY 51 S",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386689403",
            "telephone_number": "662-429-4988",
            "fax_number": "662-429-4966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2778 HIGHWAY 51 S",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386689403",
            "telephone_number": "662-429-4988",
            "fax_number": "662-429-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERNANDO FAMILY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "662-429-4988"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000735805",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLUDER MEDICAL CLINIC, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Senatobia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.