ICONIC MIND (NPI# 1801430590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801430590 |
| Entity Type | Organization |
| Organization Name | ICONIC MIND |
| Practice Address |
102 Crabapple Grv Madison MS 39110-7098 |
| Mailing Address |
Po Box 321 Flora MS 39071-0321 |
| Practice Telephone | 6019188041 |
| Mailing Telephone | 6019188041 |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2019-11-05 |
| Authorized Official Name | MISS KIMBERLY MICHELLE HORTON (OWNER) |
| Authorized Official Telephone | 6019188041 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
102 CRABAPPLE GRV |
| City | MADISON |
| State | MS |
| Zip Code | 39110-7098 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750840575 | Kimberly Michelle Horton | Social Worker | 102 Crabapple Grv, Madison, MS 39110-7098 | 2019-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275132946 | Alice M Franks-gray | Case Manager/Care Coordinator | Esu/bayside/crisis Stabilization, 702 W Main Street, Madison, WI 53715-1424 | 2020-10-22 |
| 1073129391 | John Raby | Case Manager/Care Coordinator | 471 Main St Ste B, Madison, WV 25130-1223 | 2020-09-22 |
| 1588272488 | Samantha Rose Vaught | Case Manager/Care Coordinator | 157 Greenwood Dr, Madison, AL 35758-1403 | 2020-07-16 |
| 1598381915 | Errica Braun | Case Manager/Care Coordinator | 4 N Hancock St, Madison, WI 53703-2802 | 2020-06-22 |
| 1093350563 | The Hmong Institute Incorporated | Case Manager/Care Coordinator | 4402 Femrite Dr, Madison, WI 53716-4122 | 2019-11-08 |
| 1548818776 | James Martin | Case Manager/Care Coordinator | 315 Sw Jeanette Cir, Madison, FL 32340-1155 | 2019-08-30 |
| 1275185522 | Selina Lor | Case Manager/Care Coordinator | 17 Daystar Ct Apt D, Madison, WI 53704-7354 | 2019-07-16 |
| 1154897163 | Avenues To Community Inc | Case Manager/Care Coordinator | 579 Donofrio Dr Ste 208, Madison, WI 53719-2839 | 2018-10-17 |
| 1023518214 | Anthony Dwain Pettus Jr. | Case Manager/Care Coordinator | 100 Spenryn Dr, Madison, AL 35758-1890 | 2018-02-14 |
| 1720507585 | Heather Marie Forney | Case Manager/Care Coordinator | 208 E Olin Ave, Madison, WI 53713-1434 | 2017-09-13 |
| Find all providers in MADISON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.