FAITH FAMILY CLINIC OF BOONEVILLE
NPI 1063911485
Clinic/Center - Primary Care in Booneville, MS
About Faith Family Clinic Of Booneville NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FAITH FAMILY CLINIC OF BOONEVILLE (NPI 1063911485) is a healthcare organization registered as a primary care in Booneville, Mississippi and active in the NPI registry since February 2018. The organization holds a CLIA Certificate of Compliance certificate valid through September 17, 2028 and lists Amber Janzen, Fnp, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Faith Family Clinic Of Booneville is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Faith Family Clinic Of Booneville, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Compliance 25D1058512
Faith Family Clinic Of Booneville, LLC · Booneville, MSFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Faith Family Clinic Of Booneville's NPI number?
The NPI number for Faith Family Clinic Of Booneville is 1063911485. It was assigned to this organization in the NPPES registry on February 12, 2018.
Where is Faith Family Clinic Of Booneville located?
Faith Family Clinic Of Booneville is located at 2209 N 2nd St, Booneville, MS 38829. The listed phone number is (662) 728-0162.
What is Faith Family Clinic Of Booneville's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Faith Family Clinic Of Booneville enrolled in Medicare?
Yes. Faith Family Clinic Of Booneville is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Faith Family Clinic Of Booneville?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Faith Family Clinic Of Booneville. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Faith Family Clinic Of Booneville hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 25D1058512) is associated with this NPI, valid through September 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Faith Family Clinic Of Booneville was last updated on February 12, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Faith Family Clinic Of Booneville · NPI 1063911485
Primary Care organization in Booneville, Mississippi. Organization record, active in the CMS NPPES registry since February 12, 2018.
## Identity
- **NPI:** 1063911485 (Entity type: Organization)
- **Enumerated:** February 12, 2018
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Amber Janzen, FNP
## Practice location
- **Address:** 2209 N 2ND ST, Booneville, MS 38829-7734
- **Phone:** (662) 728-0162 · **Fax:** (662) 728-0326
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 12, 2018
- **Other identifiers:** Medicaid 05850217 (MS)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063911485) · Data from the CMS NPPES public registry.