Prime Care Clinic of Clinton, LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

PRIME CARE CLINIC OF CLINTON, LLC

Practice address

709 Clinton Pkwy
Clinton, MS 39056-5245

Phone

(601) 259-9532

NPI assigned

Dec 13, 2021

Organization subpart

No

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

Authorized official

Name

Justin C Jackson

Title

Member/Coo

Phone

(601) 519-7692

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Hunter Tillery Gelston, FNP

  • Primary Care Nurse Practitioner
  • Clinton, MS
  • NPI 1609689140
  Medicare reassignment NPD
• Courtney Rae Gordon, NP

  • Nurse Practitioner
  • Ridgeland, MS
  • NPI 1891312948
  Medicare reassignment NPD
• Melissa Barham Jackson, NP

  • Nurse Practitioner
  • Jackson, MS
  • NPI 1578049276
  Medicare reassignment NPD

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

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1790444263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 785",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390600785",
            "telephone_number": "601-519-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 CLINTON PKWY",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565245",
            "telephone_number": "601-259-9532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE CLINIC OF CLINTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-13",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MEMBER/COO",
        "authorized_official_telephone_number": "601-519-7692"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578049276",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Pittman, MS,PCMHT
• Abby Hall Pitts
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• Rachel Lani Price
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• Mary Lou C Puglese, OD
• Pure Joy Mississippi, LLC
• Pure Joy Mississippi, LLC

• Adult Health Nurse Practitioner in Clinton, MS
• Providers in Clinton, MS by specialty
• Adult Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.