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LACKEY PEDIATRIC CLINIC
NPI 1154670719
Clinic/Center - Rural Health in Forest, MS

Active since August 29, 2012CLIA 25D2048983 · Waiver
1129 HIGHWAY 35 S, SUITE 1, FOREST, MS 39074(601) 849-6440(601) 849-1318 Get Directions Write a Review

NPPES record last updated: May 26, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 26, 2020, Dec 3, 2015 (2 updates tracked since 2015).

About Lackey Pediatric Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LACKEY PEDIATRIC CLINIC (NPI 1154670719) is a healthcare organization registered as a rural health in Forest, Mississippi and active in the NPI registry since August 2012. The organization holds a CLIA Waiver certificate valid through October 25, 2026 and lists John P Lee, Chairman Of The Board, as its authorized official.

NPPES Registry Identity

NPI1154670719
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameINDEPENDENT HEALTHCARE MANAGEMENT, INC.
Location Address1129 HIGHWAY 35 S, SUITE 1Forest, MS 39074-8829
Mailing Address1129 Highway 35 S, Suite 1Forest, MS 39074-8829 · (601) 849-6440 · Fax (601) 849-1318
Phone(601) 849-6440
Fax(601) 849-1318
Organization SubpartNo
Authorized OfficialJohn P LeeChairman Of The Board · (601) 849-6440
Enumeration DateAugust 29, 2012
Last NPPES UpdateMay 26, 20202 updates tracked since enumeration
NPPES CertifiedMay 26, 2020
✔ NPI 1154670719 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
Also ListedClinic/CenterTaxonomy 261Q00000X · License 13-033 (MS)
1129 HIGHWAY 35 S, Forest, MS 39074
Open in Google Maps ↗

Other Names 1

Doing Business AsLackey Pediatric Clinic

Other Identifiers 1

Other13033MS · License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lackey Pediatric Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

94

Medicare enrollment records show 94 clinicians reassign Medicare billing to Lackey Pediatric Clinic, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 17 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 13

Nurse Practitioner39
Emergency Medicine18
Certified Registered Nurse Anesthetist (CRNA)13
Family Practice8
Internal Medicine6
General Surgery2
Pediatric Medicine2
Anesthesiology1
5 other specialties5

Nearest to this location (20)

See all 94
Kaitlyn Flickner
Clinical Social Worker
NPI 1811682099
1129 HIGHWAY 35 S STE 1
Forest, MS 39074
(601) 469-3320
✔ PECOS✔ Accepts MedicareSame address
Mary Paul, PMHNP-BC
Nurse Practitioner
NPI 1336780527
1129 HIGHWAY 35 S STE 1
Forest, MS 39074
(601) 469-3320
✔ PECOS✔ Accepts MedicareSame address
Corey Shoemaker
Nurse Practitioner
NPI 1629403704
1123 HIGHWAY 35 S
Forest, MS 39074
(601) 469-4771
✔ PECOS✔ Accepts MedicareSame address
Shelly Boone, CFNP
Nurse Practitioner
NPI 1750797874
526 DEERFIELD DR
Forest, MS 39074
(601) 469-0291
✔ PECOS✔ Accepts Medicare0.2 mi
Bernard Harrell, D.O.
Family Practice
NPI 1871575852
1080 HIGHWAY 35 S
Forest, MS 39074
(601) 469-3555
✔ PECOS✔ Accepts Medicare0.2 mi
John Coleman, MD
Internal Medicine
NPI 1063945475
505 AIRPORT RD STE B
Forest, MS 39074
(601) 469-4771
✔ PECOS✔ Accepts Medicare0.3 mi
Anne Kimes, PMHNP
Nurse Practitioner
NPI 1700566213
505 AIRPORT RD
Forest, MS 39074
(601) 469-4151
✔ PECOS✔ Accepts Medicare0.3 mi
John Lee, M.D.
Family Practice
NPI 1992806699
1 MEDICAL LN
Forest, MS 39074
(601) 469-4861
✔ PECOS✔ Accepts Medicare0.3 mi
William Lewis, M.D.
Family Practice
NPI 1346341054
1 MEDICAL LN
Forest, MS 39074
(601) 469-4861
✔ PECOS0.3 mi
Rori Bridges, FNP
Nurse Practitioner
NPI 1114170529
330 N BROAD ST
Forest, MS 39074
(601) 469-4771
✔ PECOS✔ Accepts Medicare1.3 mi
Ruth Gaddis, FNP
Nurse Practitioner
NPI 1831130715
330 N BROAD ST
Forest, MS 39074
(601) 469-4771
✔ PECOS1.3 mi
Megan Otto
Nurse Practitioner
NPI 1609323450
330 N BROAD ST
Forest, MS 39074
(601) 469-4151
✔ PECOS✔ Accepts Medicare1.3 mi
Kathryn Walker, CFNP
Nurse Practitioner
NPI 1710092986
330 N BROAD ST
Forest, MS 39074
(601) 469-4151
✔ PECOS✔ Accepts Medicare1.3 mi
Kacey Jones, NP
Nurse Practitioner
NPI 1992368799
330 N BROAD ST
Forest, MS 39074
(601) 469-4151
✔ PECOS1.3 mi
Robin Hardin, NP
Nurse Practitioner
NPI 1649762253
1 MEDICAL LN
Forest, MS 39074
(601) 469-4861
✔ PECOS✔ Accepts Medicare3.7 mi
Jena Herrington
Nurse Practitioner
NPI 1285453605
1 MEDICAL LN
Forest, MS 39074
(601) 469-3320
✔ PECOS3.7 mi
Donna Wedgeworth
Nurse Practitioner
NPI 1952865214
1 MEDICAL LN STE B
Forest, MS 39074
(601) 469-4861
✔ PECOS✔ Accepts Medicare3.7 mi
Jasmeet Kaur
Internal Medicine
NPI 1376004150
347 S FOURTH ST
Morton, MS 39117
(601) 732-1524
✔ PECOS✔ Accepts Medicare10 mi
Daniel Walker, NP
Nurse Practitioner
NPI 1740615814
347 S FOURTH ST
Morton, MS 39117
(601) 732-1524
✔ PECOS✔ Accepts Medicare10 mi
Mohammad Arain, MD
Pediatric Medicine
NPI 1114909199
208 S MAIN ST
Newton, MS 39345
(601) 683-0279
✔ PECOS19 mi
See all 94 clinicians

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 Waiver 25D2048983

Lackey Pediatric Clinic · Forest, MS
Active · expires Oct 25, 2026
CLIA Number25D2048983
Laboratory TypePhysician Office
Certificate Effective DateOctober 26, 2024
Certificate Expiration DateOctober 25, 2026
Laboratory DirectorDr. Mohommad Arain
Laboratory Phone(601) 469-3320
Laboratory LocationLackey Pediatric Clinic1 Medical Lane, Forest, MS 39074
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently 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 Independent Healthcare Management, Inc.'s NPI number?

The NPI number for Independent Healthcare Management, Inc. is 1154670719. It was assigned to this organization in the NPPES registry on August 29, 2012. The provider is doing business as Lackey Pediatric Clinic.

Where is Independent Healthcare Management, Inc. located?

Independent Healthcare Management, Inc. is located at 1129 Highway 35 S Suite 1, Forest, MS 39074. The listed phone number is (601) 849-6440.

What is Independent Healthcare Management, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Is Independent Healthcare Management, Inc. enrolled in Medicare?

Yes. Independent Healthcare Management, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Independent Healthcare Management, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 94 clinicians in 13 Medicare specialties reassign their Medicare billing to Independent Healthcare Management, Inc.. 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. The largest specialties are Nurse Practitioner (39), Emergency Medicine (18) and Certified Registered Nurse Anesthetist (CRNA) (13). Of these, 3 practice at this address and 17 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Independent Healthcare Management, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2048983) is associated with this NPI, valid through October 25, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Independent Healthcare Management, Inc. accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 2 other insurers list Independent Healthcare Management, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Independent Healthcare Management, Inc. was last updated on May 26, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.