NPIMap

Organization Active NPI

Greater Meridian Health Clinic, Inc.

Doing business as Kemper Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • De Kalb, MS
National Provider Identifier
1982701223
Registry record updated May 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER MERIDIAN HEALTH CLINIC, INC.
Doing business as
Kemper Family Medical Center
Practice address
201 Birch St
De Kalb, MS 39328-8017
Phone
(601) 743-2642
Fax
(844) 778-8922
NPI assigned
Sep 20, 2006
Last updated
May 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GREATER MERIDIAN HEALTH CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 3, 2024

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

Authorized official

Name
Wilbert L. Jones
Title
Ceo
Phone
(601) 693-0118

Specialties & licenses 1

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

Addresses

Primary practice location

201 Birch St
De Kalb, MS 39328-8017

Mailing address

2701 Davis St
Meridian, MS 39301-5708
Phone (601) 693-0118

Other identifiers 1

IdentifierTypeStateIssuer
009014691MedicaidMS

Other names 1

  • Kemper Family Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040217000471 MS Part B Supplier - Clinic/Group Practice 9032027834 Receives reassigned benefits from 16 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Meridian, MS; Starkville, MS; Scooba, MS; Macon, MS; Louisville, MS; Dekalb, MS
O20101202001258 MS Part A Provider - Federally Qualified Health Center (FQHC) 9032027834 Practice locations: De Kalb, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982701223. Details of each certification follow.

Federally qualified health center certification: CCN 251847

Legal name
GREATER MERIDIAN HEALTH CLINIC, INC.
Doing business as
KEMPER FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1994
Last certification
Oct 1, 1994
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 1993 in MS
Enrollment address
201 Birch St
De Kalb, MS 39328-8017
Related CCNs
251833

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Part of
Greater Meridian HLTH C

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Ronald Turner Individual Corporate OfficerBoard Vice-President Jan 1, 2020
Ralph Henson Individual Corporate DirectorBoard Director Jan 1, 2023
Gwendolyn Hughes Individual Corporate OfficerTreasurer Jan 1, 2020
Tonya M Hunt Individual Corporate DirectorBoard Member Jan 3, 2012
Deborah Todd Individual Corporate DirectorBoard Member Oct 30, 1986
Jennifer Gentry Individual Corporate DirectorBoard Director Jan 1, 2023
Latoria Brown Individual Corporate DirectorBoard Member Jan 1, 2020
Jimmie Smith Individual Corporate DirectorBoard Member Mar 30, 1989
Michelle Stewart Individual Corporate OfficerCfo Jan 15, 2015
Wilbert L. Jones Individual Corporate OfficerCeo Jan 7, 2015
Operational/Managerial ControlCeo Jan 7, 1980
Lisa Silliman Individual Corporate DirectorBoard Member Jan 1, 2020
Melvin R Robinson Individual Corporate DirectorBoard Member Mar 26, 1998
Laura Carmichael Individual Corporate DirectorBoard Director Jan 1, 2019
Dede Mogollon Individual Corporate OfficerSecretary Jan 1, 2020

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Oktibbeha Family Medical ClinicStarkville, MS, CCN 251919 Federally qualified health center Operational/Managerial Control Oct 6, 2003
Shuqualak-Noxubee Health ClinicMacon, MS, CCN 251834 Federally qualified health center Operational/Managerial Control Aug 1, 1987
GMHC, Inc./MPSD West End/T J Harris Community School Base ClinicMeridian, MS, CCN 251069 Federally qualified health center Operational/Managerial Control Nov 16, 2017
GMHC, Inc./MPSD Meridian High School Community School Based ClinicMeridian, MS, CCN 251090 Federally qualified health center Operational/Managerial Control May 1, 2019
Greater Meridian Health Clinic, Inc.Meridian, MS, CCN 251137 Federally qualified health center Operational/Managerial Control Oct 1, 1986

Owned or controlled facilities with NPI records 5

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714694400000",
    "number": "1982701223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 DAVIS ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393015708",
            "telephone_number": "601-693-0118",
            "fax_number": "601-965-0324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 BIRCH ST",
            "city": "DE KALB",
            "state": "MS",
            "postal_code": "393288017",
            "telephone_number": "601-743-2642",
            "fax_number": "844-778-8922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER MERIDIAN HEALTH CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREATER MERIDIAN HEALTH CLINIC, INC.",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "WILBERT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-693-0118"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009014691",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kemper Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Kalb, MS

Sources for this page

Verify at the official NPI Registry.