Toccopola Family Medical Clinic, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

TOCCOPOLA FAMILY MEDICAL CLINIC, LLC

Doing business as

Toccopola Family Medical Clinic

Practice address

7908 Hwy 334
Toccopola, MS 38874-0389

Phone

(662) 281-8020

Fax

(662) 281-8020

NPI assigned

Mar 8, 2007

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Michelle Poole Roberts, FNPNPI 1861815623

Title

Owner

Phone

(662) 281-8003

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Toccopola Family Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780715912. Details of each certification follow.

• CCN 253820 Rural health clinic · Active · Details

Rural health clinic certification: CCN 253820

Legal name

TOCCOPOLA FAMILY MEDICAL CLINIC LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

May 11, 2010

Last certification

Jul 7, 2022

Ownership / control type

1A

Organization structure

LLCProprietary

Enrollment address

7908 Hwy 334
Toccopola, MS 38874-0389

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• Michelle Poole Roberts, FNP-C

  • Family Nurse Practitioner
  • Toccopola, MS
  • NPI 1861815623

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

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.

• Michelle Poole Roberts, FNP-C

  • Family Nurse Practitioner
  • Toccopola, MS
  • NPI 1861815623
  Medicare reassignment Authorized official
• Donna Hill, FNP

  • Family Nurse Practitioner
  • Toccopola, MS
  • NPI 1750619292
  NPD (past)

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780715912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 389",
            "city": "TOCCOPOLA",
            "state": "MS",
            "postal_code": "388740389",
            "telephone_number": "662-281-8003",
            "fax_number": "662-281-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7908 HWY 334",
            "city": "TOCCOPOLA",
            "state": "MS",
            "postal_code": "388740389",
            "telephone_number": "662-281-8020",
            "fax_number": "662-281-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOCCOPOLA FAMILY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "POOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-281-8003",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R549002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014299",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Toccopola Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donna Hill, FNP
• Michelle Poole Roberts, FNP-C

• Rural Health Clinic/Center in Toccopola, MS
• Providers in Toccopola, MS by specialty
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.