GRAYSON CREEK MEDICAL CLINIC, LLC
NPI 1184166035
Nurse Practitioner - Pediatrics in Moselle, MS
About Grayson Creek Medical Clinic, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRAYSON CREEK MEDICAL CLINIC, LLC (NPI 1184166035) is a healthcare organization registered as a pediatrics in Moselle, Mississippi and active in the NPI registry since November 2016. The organization holds a CLIA Waiver certificate valid through September 9, 2028 and lists Mack E Knight, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 1
Group Practice 1
Accepted 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)
Grayson Creek Medical Clinic, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
10Medicare enrollment records show 10 clinicians reassign Medicare billing to Grayson Creek Medical Clinic, LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (10)
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 25D2122171
Grayson Creek Medical Clinic · Moselle, 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 Grayson Creek Medical Clinic, LLC's NPI number?
The NPI number for Grayson Creek Medical Clinic, LLC is 1184166035. It was assigned to this organization in the NPPES registry on November 9, 2016.
Where is Grayson Creek Medical Clinic, LLC located?
Grayson Creek Medical Clinic, LLC is located at 3 John Everett Rd, Moselle, MS 39459. The listed phone number is (601) 620-9991.
What is Grayson Creek Medical Clinic, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.
Is Grayson Creek Medical Clinic, LLC enrolled in Medicare?
Yes. Grayson Creek Medical Clinic, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Grayson Creek Medical Clinic, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 10 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Grayson Creek Medical Clinic, LLC. 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, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Grayson Creek Medical Clinic, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D2122171) is associated with this NPI, valid through September 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Grayson Creek Medical Clinic, LLC 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 Grayson Creek Medical Clinic, LLC 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 Grayson Creek Medical Clinic, LLC was last updated on October 19, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.
# Grayson Creek Medical Clinic, Llc · NPI 1184166035
Pediatrics organization in Moselle, Mississippi. Organization record, active in the CMS NPPES registry since November 9, 2016.
## Identity
- **NPI:** 1184166035 (Entity type: Organization)
- **Enumerated:** November 9, 2016
- **Primary specialty:** Nurse Practitioner - Pediatrics · taxonomy 363LP0200X
- **Organization subpart:** No
- **Authorized official:** Mack Knight, OWNER
## Practice location
- **Address:** 3 JOHN EVERETT RD, Moselle, MS 39459-9771
- **Phone:** (601) 620-9991
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 10 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 19, 2017
- **Other identifiers:** Medicaid 0044232 (MS)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1184166035) · Data from the CMS NPPES public registry.