NPIMap

Organization Active NPI

The Chadwick Clinic LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1801538186
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
THE CHADWICK CLINIC LLC
Practice address
609 Brunson Dr Ste B
Tupelo, MS 38801-4948
Phone
(662) 432-1097
Fax
(662) 432-1098
NPI assigned
Apr 8, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Authorized official

Name
Beth Clardy
Title
Manager
Phone
(662) 871-0911

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

609 Brunson Dr Ste B
Tupelo, MS 38801-4948

Mailing address

PO Box 480
Corinth, MS 38835-0480

Other practice location 1

3514 Highway 39 N Ste A&b
Meridian, MS 39301-1305
Phone (601) 512-1310

Other practice location 2

109 Doctors Park
Starkville, MS 39759-2174
Phone (662) 465-2065

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220823004048 MS Part B Supplier - Clinic/Group Practice 5092198028 Receives reassigned benefits from 9 practitioners
Practice locations: Tupelo, 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
25D2265862Chadwick Clinic, the609 Brunson Dr Ste B, Tupelo, MS 38801Certificate of waiverAug 1, 2026

National Provider Directory

National Provider Directory

Locations

3514 Highway 39 N
Ste Ab
Meridian, MS 39301
Phone (601) 512-1310

609 Brunson Dr
Ste B
Tupelo, MS 38801
Phone (662) 432-1097

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26357/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1649376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1801538186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 480",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388350480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 BRUNSON DR STE B",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014948",
            "telephone_number": "662-432-1097",
            "fax_number": "662-432-1098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3514 Highway 39 N Ste A&b",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393011305",
            "country_code": "US",
            "telephone_number": "601-512-1310",
            "fax_number": "601-512-1317",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 Doctors Park",
            "address_purpose": "LOCATION",
            "city": "Starkville",
            "state": "MS",
            "postal_code": "397592174",
            "country_code": "US",
            "telephone_number": "662-465-2065",
            "fax_number": "662-465-2066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE CHADWICK CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-08",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A",
        "authorized_official_last_name": "CLARDY",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "662-871-0911"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.