Jackson Free Clinic

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

JACKSON FREE CLINIC

Practice address

925 Martin Luther King Jr Dr
Jackson, MS 39203-2233

Phone

(601) 355-5161

NPI assigned

Aug 24, 2021

Last updated

Jun 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

Hali Peterson

Title

Chair of the Board

Phone

(601) 355-5161

Specialties & licenses 1

Addresses

Other names 1

• Jackson Free Clinic for the Homeless Former legal business name

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

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20428/brand/1/csg/1/fhir/r4

Practitioners 4

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.

• Kimberly Holt, PT, DPT

  • Physical Therapist
  • Jackson, MS
  • NPI 1235942772
  NPD
• Joseph Dodd, MD

  • General Practice Physician
  • Atlanta, GA
  • NPI 1306591656
  NPD
• Sunna Savani, MD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1487404547
  NPD
• Adam Christian Davis

  • Student in an Organized Health Care Education/Training Program
  • Jackson, MS
  • NPI 1750122545
  NPD (past)

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655769600000",
    "number": "1851068324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4892",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392964892",
            "telephone_number": "601-355-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 MARTIN LUTHER KING JR DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392032233",
            "telephone_number": "601-355-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-24",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "HALI",
        "authorized_official_title_or_position": "CHAIR OF THE BOARD",
        "authorized_official_telephone_number": "601-355-5161"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Free Clinic for the Homeless",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Jackson Free Clinic for the Homeless",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jackson Ear, Nose and Throat PA
• Jackson Eye Associates PLLC (JEA Optical Jackson)
• Jackson Eye Institute Ambulatory Surgery Center LLC
• Jackson Eye Institute PLLC
• Jackson Family First
• Jackson Gynecologic Oncology PLLC
• Jackson Hand and Upper Extremity
• Jackson HB Medical Services LLC (Merit Health Central)
• Jackson Healthcare for Women PA
• Jackson Healthcare for Women PA

• Voluntary or Charitable Agency in Jackson, MS
• Providers in Jackson, MS by specialty
• Voluntary or Charitable Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.