EMMANUEL RIDGE OF DEKALB INC — NPI 1992191084 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in DEKALB, MS)

CMS-1500 Box 24J / 33a • NPI

1992191084

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QA0600X

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

14632 HWY 39N/16E, DEKALB, MS, 39328

Official NPPES Practice Location

Practice Phone & Referral Fax

(601) 927-9839

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1992191084 (EMMANUEL RIDGE OF DEKALB INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1992191084` (NPI-2 Organization / Facility)
Provider / Legal Name	EMMANUEL RIDGE OF DEKALB INC
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QA0600X` (Clinic/Center, Adult Day Care)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	14632 HWY 39N/16E, DEKALB, MS, 39328
Practice Telephone / Fax	Tel: (601) 927-9839
Administrative Mailing Address	PO BOX 1522, FLORENCE, MS, 39073-1522
Enumeration & Last Sync	Enumerated: 2015-04-15 \| CMS Record Updated: 2015-04-15
Authorized Official	BEATRICE EZEM (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

14632 HWY 39N/16E, DEKALB, MS, 39328

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Plain-English Taxonomy & CMS Crosswalk (261QA0600X)

What Does Taxonomy Code 261QA0600X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QA0600X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (EMMANUEL RIDGE OF DEKALB INC)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`163WA2000X` — Registered Nurse, Administrator Plain English: Licensed & Credentialed Registered Nurse, Administrator	State: MS \| License: `R815521` \| Primary: Secondary
`251T00000X` — PACE Provider Organization Plain English: Licensed & Credentialed PACE Provider Organization	State: MS \| License: `08752218` \| Primary: Secondary
`253Z00000X` — In Home Supportive Care Plain English: Licensed & Credentialed In Home Supportive Care	State: MS \| License: `03630719` \| Primary: Secondary
`261QA0600X` — Clinic/Center, Adult Day Care Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: MS \| License: `08752218` \| Primary: Yes (Primary)

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EMMANUEL RIDGE OF DEKALB INC (NPI #1992191084)