NPIMap

Organization Active NPI

G a Carmichael Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Canton, MS
National Provider Identifier
1801952809
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
G A CARMICHAEL FAMILY HEALTH CENTER INC
Practice address
1668 West Peace Street
Canton, MS 39046
Phone
(601) 859-5213
Fax
(601) 859-8771
NPI assigned
Dec 28, 2006
Last updated
Oct 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Dr. James L. Coleman Jr., ED.D.
Title
Ceo
Phone
(601) 859-5213

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MS Primary
Federally Qualified Health Center (FQHC) 261QF0400X NU

Addresses

Primary practice location

1668 West Peace Street
Canton, MS 39046

Mailing address

PO Box 588
Canton, MS 39046-0588
Phone (601) 859-5213

Other identifiers 1

IdentifierTypeStateIssuer
09010018MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050816001055 MS Part B Supplier - Clinic/Group Practice 2567371032 Receives reassigned benefits from 24 practitioners
17 other NPIs on this enrollment
Practice locations: Belzoni, MS; Yazoo City, MS; Vaughan, MS; Greenwood, MS; Carthage, MS; Canton, MS; Bentonia, MS
O20101213000810 MS Part A Provider - Federally Qualified Health Center (FQHC) 2567371032 Practice locations: Canton, MS
O20231204001177 MS MDPP Supplier - in-Person MDPP Supplier 2567371032 Practice locations: Canton, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801952809. Details of each certification follow.

Federally qualified health center certification: CCN 251806

Legal name
G A CARMICHAEL FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1973 in MS
Enrollment address
1668 W Peace St
Canton, MS 39046-5332

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
M Y L Family Health Ctr26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

10340 Highway 433 W
Bentonia, MS 39040
Phone (662) 755-2518

1825 Martin Luther King Dr
Yazoo City, MS 39194
Phone (662) 746-1514

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Rosie Evan-Williams Individual Corporate Director Oct 1, 2013
Casey Payne Individual Corporate Director Feb 1, 2018
W-2 Managing Employee Feb 1, 2018
Keith Warfieldd Individual Corporate Director Oct 1, 2010
Joseph Davis Individual Corporate DirectorCoo Jun 20, 2016
Gregory Moseley Individual Corporate Director Oct 1, 2010
Deloris Harris Individual Corporate Director Aug 30, 2017
Moses Thompson Individual Corporate Director Oct 1, 2010
Charles Henderson Individual Corporate Director Aug 30, 2017
Veda Horton Individual Corporate Director Aug 30, 2017
Karl Sykes Individual Corporate Director Aug 30, 2017

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
G a Carmichael Family Health Center, Inc.Carthage, MS, CCN 251143 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 26, 2021
G a Carmichael Family Health Center, IncGreenwood, MS, CCN 251158 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 26, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1801952809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 588",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390460588",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1668 WEST PEACE STREET",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "39046",
            "telephone_number": "601-859-5213",
            "fax_number": "601-859-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G A CARMICHAEL FAMILY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-859-5213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09010018",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MS

Sources for this page

Verify at the official NPI Registry.