Imani Family Medical Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

R803867 Issued in MS

Legal business name

IMANI FAMILY MEDICAL CLINIC, LLC

Practice address

4510 Hanging Moss Rd
Jackson, MS 39206-3962

Phone

(769) 257-5713

Fax

(769) 257-5715

NPI assigned

Jan 7, 2016

Organization subpart

No

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

Authorized official

Name

Nkeba I Bell, FNPNPI 1750317400

Title

Owner

Phone

(601) 421-7242

Specialties & licenses 1

Addresses

Other identifiers 2

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

Practitioners 1

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

• Nkeba I Bell, CFNP

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1750317400

  MS

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1851757785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 HANGING MOSS RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 HANGING MOSS RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063962",
            "telephone_number": "769-257-5713",
            "fax_number": "769-257-5715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMANI FAMILY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-07",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "NKEBA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-421-7242",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "R803867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117713",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "501534",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Jackson, MS
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.