LIFECORE HEALTH GROUP
NPI 1679903546
Clinic/Center - Rural Health in Tupelo, MS

Active since November 13, 2013CLIA Certified · 2 labs
499 GLOSTER CREEK VLG, SUITE A-3, TUPELO, MS 38801(662) 844-1717(662) 680-6416 Get Directions Write a Review

NPPES record last updated: February 27, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Lifecore Health Group NPPES

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

LIFECORE HEALTH GROUP (NPI 1679903546) is a healthcare organization registered as a rural health in Tupelo, Mississippi and active in the NPI registry since November 2013. The organization holds 2 active CLIA laboratory certificates and lists Rita Berthay, Ceo, as its authorized official.

NPPES Registry Identity

NPI1679903546
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameNORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION
Location Address499 GLOSTER CREEK VLG, SUITE A-3Tupelo, MS 38801-4600
Mailing Address2434 S Eason BlvdTupelo, MS 38804-6942 · (662) 640-4595 · Fax (662) 680-6416
Fax(662) 680-6416
Organization SubpartNo
Authorized OfficialRita BerthayCeo · (662) 640-4595
Enumeration DateNovember 13, 2013
Last NPPES UpdateFebruary 27, 2020
✔ NPI 1679903546 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/Center · Multi-SpecialtyTaxonomy 261QM1300X
499 GLOSTER CREEK VLG, Tupelo, MS 38801

Other Names 1

Doing Business AsLifecore Health Group

Other Identifiers 3

Medicaid000MS
Other0000MS · Blue Cross
Medicaid0000000MS

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)

Lifecore Health Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

16

Medicare enrollment records show 16 clinicians reassign Medicare billing to Lifecore Health Group, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 10 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 5

Nurse Practitioner7
Mental Health Counselor4
Clinical Social Worker2
Psychiatry2
Clinical Psychologist1

Clinicians, nearest first (16)

Nurse Practitioner
NPI 1871674713
499 GLOSTER CREEK VLG SUITE A-3
Tupelo, MS 38801
(662) 844-1717
✔ PECOSSame address
Nurse Practitioner
NPI 1427206556
499 GLOSTER CREEK VLG STE. A-2
Tupelo, MS 38801
(662) 620-6800
✔ PECOS0.1 mi
Nurse Practitioner
NPI 1801009592
670 CROSSOVER RD
Tupelo, MS 38801
(662) 844-8414
✔ PECOS0.6 mi
Psychiatry
NPI 1578654851
REGION III MENTAL HEALTH CENTER 2434 SOUTH EASON BLVD
Tupelo, MS 38804
(662) 844-1717
✔ PECOS2.8 mi
Nurse Practitioner
NPI 1275970725
2434 S EASON BLVD
Tupelo, MS 38804
(662) 844-1717
✔ PECOS✔ Accepts Medicare2.9 mi
Mental Health Counselor
NPI 1932805298
2434 S EASON BLVD
Tupelo, MS 38804
(662) 640-4595
✔ PECOS2.9 mi
Psychiatry
NPI 1508893074
2434 S EASON BLVD
Tupelo, MS 38804
(662) 844-1717
✔ PECOS✔ Accepts Medicare3.0 mi
Clinical Social Worker
NPI 1629172119
2434 S EASON BLVD
Tupelo, MS 38804
(662) 844-1717
✔ PECOS3.1 mi
Mental Health Counselor
NPI 1336802735
2434 S EASON BLVD
Tupelo, MS 38804
(662) 640-4595
✔ PECOS✔ Accepts Medicare3.1 mi
Clinical Social Worker
NPI 1467543785
LIFECORE HEALTH GROUP 2434 SOUTH EASON BLVD
Tupelo, MS 38804
(662) 640-4595
✔ PECOS✔ Accepts Medicare3.2 mi
Clinical Psychologist
NPI 1962597708
152 HIGHWAY 7 S
Oxford, MS 38655
(662) 234-7521
✔ PECOS✔ Accepts Medicare16 mi
Mental Health Counselor
NPI 1245384213
223 E WASHINGTON ST
Houston, MS 38851
(662) 456-9977
✔ PECOS✔ Accepts Medicare29 mi
Nurse Practitioner
NPI 1508553512
3747 HIGHWAY 51 S
Senatobia, MS 38668
(662) 612-4549
✔ PECOS✔ Accepts Medicare76 mi
Nurse Practitioner
NPI 1649753161
8626 AIRWAYS BLVD
Southaven, MS 38671
(662) 832-0302
✔ PECOS✔ Accepts Medicare88 mi
Mental Health Counselor
NPI 1841488517
1415 COLLEGE DR
Meridian, MS 39307
(601) 483-4821
✔ PECOS✔ Accepts Medicare130 mi
Nurse Practitioner
NPI 1811511819
64 OLD AIRPORT RD
Hattiesburg, MS 39401
(601) 909-9390
✔ PECOS✔ Accepts Medicare208 mi

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 2

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 25D2003856

Lifecore Health Group · Tupelo, MS
Active · expires Feb 18, 2028
CLIA Number25D2003856
Laboratory TypeCommunity Mental Health
Certificate Effective DateFebruary 19, 2026
Certificate Expiration DateFebruary 18, 2028
Laboratory DirectorRicardo J. Fraga
Laboratory Phone(662) 640-4595
Laboratory LocationLifecore Health Group2434 South Eason Blvd, Tupelo, MS 38804
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 25D2070628

Lifecore Health Group · Tupelo, MS
Active · expires Dec 19, 2027
CLIA Number25D2070628
Laboratory TypeRural Health Clinic
Certificate Effective DateDecember 20, 2025
Certificate Expiration DateDecember 19, 2027
Laboratory DirectorRicardo Fraga
Laboratory Phone(662) 640-4595
Laboratory LocationLifecore Health Group499 Gloster Creek Village Suite A-3, Tupelo, MS 38801
CLIA data matches this NPI record on: Name Phone
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 Northeast Mental Health-Mental Retardation Commission's NPI number?

The NPI number for Northeast Mental Health-Mental Retardation Commission is 1679903546. It was assigned to this organization in the NPPES registry on November 13, 2013. The provider is doing business as Lifecore Health Group.

Where is Northeast Mental Health-Mental Retardation Commission located?

Northeast Mental Health-Mental Retardation Commission is located at 499 Gloster Creek Vlg Suite A-3, Tupelo, MS 38801. The listed phone number is (662) 844-1717.

What is Northeast Mental Health-Mental Retardation Commission's specialty?

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

Is Northeast Mental Health-Mental Retardation Commission enrolled in Medicare?

Yes. Northeast Mental Health-Mental Retardation Commission is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Northeast Mental Health-Mental Retardation Commission?

According to the CMS Revalidation Reassignment List (October 2026 release), 16 clinicians in 5 Medicare specialties reassign their Medicare billing to Northeast Mental Health-Mental Retardation Commission. 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 (7), Mental Health Counselor (4) and Clinical Social Worker (2). Of these, 1 practice at this address and 10 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Northeast Mental Health-Mental Retardation Commission hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Northeast Mental Health-Mental Retardation Commission accept?

Health plans from Molina Healthcare and UnitedHealthcare list Northeast Mental Health-Mental Retardation Commission 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 Northeast Mental Health-Mental Retardation Commission was last updated on February 27, 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.