IVYRAINE WOMEN'S CLINIC
NPI 1962166264
Nurse Practitioner - Women's Health in Southaven, MS
About Ivyraine Women's Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IVYRAINE WOMEN'S CLINIC (NPI 1962166264) is a healthcare organization registered as a women's health in Southaven, Mississippi and active in the NPI registry since October 2021. The organization holds a CLIA Microscopy certificate valid through March 7, 2028 and lists Jennifer Fredrickson, Np, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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)
Ivyraine Women's Clinic 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
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Ivyraine Women's Clinic, 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 for Provider-Performed Microscopy Procedures (PPMP) 25D2243740
Ivyraine Women's Clinic · Southaven, 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 Ivyraine Women's Clinic's NPI number?
The NPI number for Ivyraine Women's Clinic is 1962166264. It was assigned to this organization in the NPPES registry on October 24, 2021.
Where is Ivyraine Women's Clinic located?
Ivyraine Women's Clinic is located at 3964 Goodman Rd E Ste 131, Southaven, MS 38672. The listed phone number is (662) 856-8440.
What is Ivyraine Women's Clinic's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.
Is Ivyraine Women's Clinic enrolled in Medicare?
Yes. Ivyraine Women's Clinic is registered in the Medicare PECOS enrollment system.
When is Ivyraine Women's Clinic'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 Ivyraine Women's Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Ivyraine Women's Clinic. 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 Ivyraine Women's Clinic hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 25D2243740) is associated with this NPI, valid through March 7, 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 Ivyraine Women's Clinic was last updated on December 29, 2021. 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.
# Ivyraine Women's Clinic · NPI 1962166264
Women's Health organization in Southaven, Mississippi. Organization record, active in the CMS NPPES registry since October 24, 2021.
## Identity
- **NPI:** 1962166264 (Entity type: Organization)
- **Enumerated:** October 24, 2021
- **Primary specialty:** Nurse Practitioner - Women's Health · taxonomy 363LW0102X
- **Organization subpart:** No
- **Authorized official:** Jennifer Fredrickson, NP
## Practice location
- **Address:** 3964 GOODMAN RD E STE 131, Southaven, MS 38672-8762
- **Phone:** (662) 856-8440
## 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:** 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:** December 29, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1962166264) · Data from the CMS NPPES public registry.