NPIMap

Organization Active NPI

Magee After Hours Clinic PLLC

  • Physician Assistant
  • Magee, MS
National Provider Identifier
1902013584
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA024 Issued in MS
Legal business name
MAGEE AFTER HOURS CLINIC PLLC
Practice address
376 Simpson Highway 149 # a
Magee, MS 39111-3409
Phone
(601) 849-1230
Fax
(601) 849-1890
NPI assigned
May 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Charles Pruitt, M.D.NPI 1700978889
Title
Doctor
Phone
(601) 849-1230

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA024 MS Primary

Addresses

Primary practice location

376 Simpson Highway 149 # a
Magee, MS 39111-3409

Mailing address

376 Simpson Highway 149 # a
Magee, MS 39111-3409
Phone (601) 849-1230

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030607000000 MS Part A Provider - Rural Health Clinic 5092625251 Practice locations: Magee, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902013584. Details of each certification follow.

Rural health clinic certification: CCN 258970

Legal name
MAGEE AFTER HOURS CLINIC PLLC
Doing business as
MAGEE AFTER HOURS CLINIC
Certification status
Terminated Voluntary: merger or closure, Aug 31, 2025
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2004
Last certification
Mar 20, 2024
Ownership / control type
1B
Organization structure
PartnershipProprietary
Incorporated
Sep 16, 2002 in MS
Enrollment address
376 Simpson Highway 149
Ste 300
Magee, MS 39111-3569

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
25D2028484Magee After Hours Clinic376 Simpson Hwy 149, Sutie 400, Magee, MS 39111Certificate of waiverAug 16, 2027

National Provider Directory

National Provider Directory

Locations

376 Simpson Highway 149
#A
Magee, MS 39111
Phone (601) 849-1230

376 Simpson Highway 149
Ste 400
Magee, MS 39111
Phone (601) 849-1220

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Rudolph S Runnels Individual 5% Or Greater Direct Ownership Interest Sep 28, 2002
Patrick Pasco Individual 5% Or Greater Direct Ownership Interest Sep 28, 2002
Charles Pruitt Individual 5% Or Greater Direct Ownership Interest Sep 28, 2002
W-2 Managing Employee Sep 28, 2002

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902013584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "376 SIMPSON HIGHWAY 149 # A",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113409",
            "telephone_number": "601-849-1230",
            "fax_number": "601-849-1890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 SIMPSON HIGHWAY 149 # A",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113409",
            "telephone_number": "601-849-1230",
            "fax_number": "601-849-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGEE AFTER HOURS CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "601-849-1230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Magee, MS

Sources for this page

Verify at the official NPI Registry.