PRIME CARE CLINIC OF CLINTON, LLC
NPI 1790444263
Nurse Practitioner - Adult Health in Clinton, MS
About Prime Care Clinic Of Clinton, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PRIME CARE CLINIC OF CLINTON, LLC (NPI 1790444263) is a healthcare organization registered as an adult health in Clinton, Mississippi and active in the NPI registry since December 2021. The organization holds a CLIA Waiver certificate valid through February 21, 2028 and lists Justin C Jackson, Member/coo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 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)
Prime Care Clinic Of Clinton, Llc 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 Prime Care Clinic Of Clinton, LLC, 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 Waiver 25D2253545
Prime Care Clinic Of Clinton · Clinton, 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 Prime Care Clinic Of Clinton, LLC's NPI number?
The NPI number for Prime Care Clinic Of Clinton, LLC is 1790444263. It was assigned to this organization in the NPPES registry on December 13, 2021.
Where is Prime Care Clinic Of Clinton, LLC located?
Prime Care Clinic Of Clinton, LLC is located at 709 Clinton Pkwy, Clinton, MS 39056. The listed phone number is (601) 259-9532.
What is Prime Care Clinic Of Clinton, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is Prime Care Clinic Of Clinton, LLC enrolled in Medicare?
Yes. Prime Care Clinic Of Clinton, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Prime Care Clinic Of Clinton, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Prime Care Clinic Of Clinton, 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, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Prime Care Clinic Of Clinton, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D2253545) is associated with this NPI, valid through February 21, 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 Prime Care Clinic Of Clinton, LLC was last updated on January 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Prime Care Clinic Of Clinton, Llc · NPI 1790444263
Adult Health organization in Clinton, Mississippi. Organization record, active in the CMS NPPES registry since December 13, 2021.
## Identity
- **NPI:** 1790444263 (Entity type: Organization)
- **Enumerated:** December 13, 2021
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **Organization subpart:** No
- **Authorized official:** Justin Jackson, MEMBER/COO
## Practice location
- **Address:** 709 CLINTON PKWY, Clinton, MS 39056-5245
- **Phone:** (601) 259-9532
## 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:** January 25, 2022
- **Other identifiers:** Medicaid 1578049276 (MS)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1790444263) · Data from the CMS NPPES public registry.