OLIVE BRANCH FAMILY MEDICAL CENTER
NPI 1629018478
Family Medicine in Olive Branch, MS
About Olive Branch Family Medical Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
OLIVE BRANCH FAMILY MEDICAL CENTER (NPI 1629018478) is a healthcare organization registered as a family medicine in Olive Branch, Mississippi and active in the NPI registry since June 2006. The organization holds a CLIA Certificate of Compliance certificate valid through June 11, 2028, maintains a secondary practice location in Olive Branch, and lists Amy Green, Business Office Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Olive Branch Family Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
19Medicare enrollment records show 19 clinicians reassign Medicare billing to Olive Branch Family Medical Center, which bills Medicare for the services they deliver. Of these, 7 practice at this address and 9 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 2
Clinicians, nearest first (19)
Olive Branch, MS 38654
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 25D0927270
Olive Branch Family Medical Center · Olive Branch, 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 Olive Branch Family Medical Center's NPI number?
The NPI number for Olive Branch Family Medical Center is 1629018478. It was assigned to this organization in the NPPES registry on June 8, 2006.
Where is Olive Branch Family Medical Center located?
Olive Branch Family Medical Center is located at 9075 Sandidge Center Cv, Olive Branch, MS 38654. The listed phone number is (662) 895-4949.
What is Olive Branch Family Medical Center's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Olive Branch Family Medical Center enrolled in Medicare?
Yes. Olive Branch Family Medical Center is registered in the Medicare PECOS enrollment system.
When is Olive Branch Family Medical Center's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Mississippi, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Olive Branch Family Medical Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 19 clinicians in 2 Medicare specialties reassign their Medicare billing to Olive Branch Family Medical Center. 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 (17) and Family Practice (2). Of these, 7 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Olive Branch Family Medical Center hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 25D0927270) is associated with this NPI, valid through June 11, 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 Olive Branch Family Medical Center was last updated on December 21, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Olive Branch Family Medical Center · NPI 1629018478
Family Medicine organization in Olive Branch, Mississippi. Organization record, active in the CMS NPPES registry since June 8, 2006.
## Identity
- **NPI:** 1629018478 (Entity type: Organization)
- **Enumerated:** June 8, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Amy Green, BUSINESS OFFICE MANAGER
## Practice location
- **Address:** 9075 SANDIDGE CENTER CV, Olive Branch, MS 38654-3514
- **Phone:** (662) 895-4949 · **Fax:** (662) 895-6776
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, Mississippi, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 19 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (17), Family Practice (2); 7 practice at this address and 9 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 21, 2020
- **Other identifiers:** Other 1629018478
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1629018478) · Data from the CMS NPPES public registry.