NPIMap

Organization Active NPI

Independent Healthcare Management, Inc.

Doing business as Main Street Medical Clinic of Sebastopol

  • Rural Health Clinic/Center
  • Sebastopol, MS
National Provider Identifier
1760778609
Registry record updated Dec 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
INDEPENDENT HEALTHCARE MANAGEMENT, INC.
Doing business as
Main Street Medical Clinic of Sebastopol
Practice address
17509 Hwy 21
Sebastopol, MS 39359-0000
Phone
(601) 625-9818
Fax
(601) 625-9904
NPI assigned
Jun 20, 2011
Last updated
Dec 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2014

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

Authorized official

Name
Joseph S McNulty III
Title
Ceo
Phone
(601) 849-6440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

17509 Hwy 21
Sebastopol, MS 39359-0000

Mailing address

17509 Hwy 21
Sebastopol, MS 39359-0000
Phone (601) 625-9818

Other names 1

  • Main Street Medical Clinic of Sebastopol Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031215000487 MS Part B Supplier - Clinic/Group Practice 0840197232 Receives reassigned benefits from 95 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, MS; Newton, MS; Morton, MS; Magee, MS; Forest, MS

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418860800000",
    "number": "1760778609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17509 HWY 21",
            "city": "SEBASTOPOL",
            "state": "MS",
            "postal_code": "393590000",
            "telephone_number": "601-625-9818",
            "fax_number": "601-625-9904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17509 HWY 21",
            "city": "SEBASTOPOL",
            "state": "MS",
            "postal_code": "393590000",
            "telephone_number": "601-625-9818",
            "fax_number": "601-625-9904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT HEALTHCARE MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2014-12-18",
        "status": "A",
        "authorized_official_last_name": "MCNULTY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-849-6440",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Medical Clinic of Sebastopol",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sebastopol, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.