- Medicare Primary Care in State Line, MS

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is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in State Line, Mississippi. The current practice location for is 256 Main St, State Line, Mississippi. For appointments, you can reach them via phone at (601) 848-7912. The mailing address for is 10467 Corporate Dr, Gulfport, Mississippi and phone number is (228) 374-2494.

is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1528161197. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (601) 848-7912.

Contact Information

256 Main St
State Line
MS 39362-9499
(601) 848-7912
(601) 848-7461

Map and Direction


Primary Care Clinic Profile

Full Name
SpecialityClinic/Center
Location256 Main St, State Line, Mississippi
Authorized Official Name and PositionAngelique Greer (CEO)
Authorized Official Contact2283742494
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address

10467 Corporate Dr
Gulfport
MS 39503-4634

Ph: (228) 374-2494
256 Main St
State Line
MS 39362-9499

Ph: (601) 848-7912

NPI Details:

NPI Number1528161197
Provider Enumeration Date09/07/2006
Last Update Date08/16/2024

Medicare PECOS Information:

Medicare PECOS PAC ID8628989654
Medicare Enrollment IDO20170511000775

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1528161197NPI-NPPES
09228250MedicaidMS

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QF0400XClinic/center - Federally Qualified Health Center (fqhc) (* (Not Available))Primary

Reviews and Comments


Clinic/Center in State Line, MS


Primary Care Clinic
Medicare: Not Enrolled in Medicare
Practice Location: 82 Church Street, State Line, MS 39451
Phone: 601-848-7650    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.