NPIMap

Organization Active NPI

East Mississippi Medical Clinic, PLLC

  • Clinic/Center
  • Meridian, MS
National Provider Identifier
1881640142
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
14494 Issued in MS
Legal business name
EAST MISSISSIPPI MEDICAL CLINIC, PLLC
Practice address
4711 Poplar SPG Dr
Meridian, MS 39305-2622
Phone
(601) 485-7777
Fax
(601) 485-7766
NPI assigned
May 26, 2006
Last updated
Apr 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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

Authorized official

Name
Dr. Razee Ameir Ahmad, MDNPI 1235111592
Title
President
Phone
(601) 485-7777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 14494 MS Primary

Addresses

Primary practice location

4711 Poplar SPG Dr
Meridian, MS 39305-2622

Mailing address

4711 Poplar Springs Dr
Meridian, MS 39305-2622
Phone (601) 485-7777

Other identifiers 1

IdentifierTypeStateIssuer
00925081MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060602000226 MS Part B Supplier - Clinic/Group Practice 1456362557 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Meridian, MS
O20100719000848 MS Part A Provider - Rural Health Clinic 1456362557 Practice locations: Meridian, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881640142. Details of each certification follow.

Rural health clinic certification: CCN 253841

Legal name
EAST MISSISSIPPI MEDICAL CLINIC, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 21, 2010
Last certification
Oct 11, 2023
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Feb 13, 2006 in MS
Enrollment address
4711 Poplar Springs Drive
Meridian, MS 39305-2666

Other NPIs on the same Medicare enrollment 1

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

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
25D1053941East Mississippi Medical Clinic, PLLC4711 Poplar Spring Drive, Meridian, MS 39305Certificate of waiverMay 7, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Razee Ameir Ahmad Individual 5% Or Greater Direct Ownership Interest Mar 1, 2006 100%
W-2 Managing Employee Mar 1, 2006

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1881640142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 POPLAR SPRINGS DR",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052622",
            "telephone_number": "601-485-7777",
            "fax_number": "601-485-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 POPLAR SPG DR",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052622",
            "telephone_number": "601-485-7777",
            "fax_number": "601-485-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST MISSISSIPPI MEDICAL CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "AHMAD",
        "authorized_official_first_name": "RAZEE",
        "authorized_official_middle_name": "AMEIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-485-7777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "14494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00925081",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.