Scott Regional Medical Center, Inc.
Organization Active NPI Rural Health Clinic/Center · Morton, MS
NPI 1003166117 · NPPES record last updated Apr 21, 2023
Key facts
- NPI
- 1003166117
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SCOTT REGIONAL MEDICAL CENTER, INC.
- Practice address
- 321 Hwy 13 South
Morton, MS 39117 - Phone
- (601) 732-8612
- Fax
- (601) 732-1957
- NPI assigned
- Sep 17, 2012
- Organization subpart
- No
Authorized official
- Name
- Don Larkin Kennedy
- Title
- Regional Ceo
- Phone
- (601) 703-9614
Owners & managing parties with NPI records 3
-
Johnathan Lee, M.D.
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 2
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 75
Practitioners 24
-
Jessica Derrick, FNP-C
-
Lisa Michelle Gant, FNP
-
Melissa B Jackson, FNP
-
Sierra Cain, NP-C
-
Martin Wayne Carr, FNP
-
Brandon J Craft, NP
-
Connie J Gainey, FNP BC
-
Patsy Lenan Holloway, FNP BC
-
Norman Jenkins, FNP
-
Matthew B Bentley, D.O.
-
Erica A Diggs, MD
-
Glenda R. Barrett, FNP
-
Bret A Boes, M.D.
-
Frederick T Duggan, M.D.
-
Linda I. McLendon, CNM
-
Bobbie Evans Mooney, APRN
-
Angela K Skinner, FNP
-
Kristen Thames, FNP-C
-
Kimberly Ann Topping, NURSE PRACTITIONER
-
Emiley Mills, AG-ACNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2045988 | Ochsner Health Center - Morton | Certificate of waiver | Jun 6, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Rural health clinic certification: CCN 258577
- Legal name
- SCOTT REGIONAL MEDICAL CENTER, INC.
- Doing business as
- OCHSNER HEALTH CENTER- MORTON
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 18, 2013
- Last certification
- Oct 5, 2021
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 1, 2008 in MS
- Enrollment address
- 321 Highway 13 S
Morton, MS 39117-3353 - Related CCNs
- 251323
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Johnathan Y Lee |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Michael F Hulefeld |
Corporate Officer |
Nov 1, 2022 | |
| Corporate Director |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Faye Martin |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Alan Gartrell |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Peter C November |
Corporate Officer |
Nov 1, 2022 | |
| Corporate Director |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Heather Davis |
W-2 Managing Employee |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| James M Molloy |
Corporate Officer |
Jan 1, 2024 | |
| Darrell Wildman |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Ochsner Clinic Foundation |
5% Or Greater Indirect Ownership Interest | Jul 1, 2022 | 100% |
| Operational/Managerial Control | Jul 1, 2022 | ||
| Don L Kennedy |
Corporate Officer |
Jul 1, 2022 | |
| W-2 Managing Employee |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Rush Health Systems Inc |
5% Or Greater Direct Ownership Interest | Jul 1, 2022 | 100% |
| Operational/Managerial Control | Nov 1, 2012 | ||
| David L Butler |
Corporate Officer |
Jul 1, 2022 | |
| W-2 Managing Employee |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080423000448 | MS | Part B Supplier - Clinic/Group Practice | 0648366260 |
Receives reassigned benefits from 57 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Forest, MS; Lake, MS; Morton, MS |
| O20130722000067 | MS | Part a Provider - Rural Health Clinic | 0648366260 | Practice locations: Morton, MS |
National Provider Directory
- Tax ID family
- Scott Regional Med Ctr Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife |
176B00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
321 Hwy 13 South
Morton, MS 39117
Mailing address
Dept 3029 PO Box 1000
Memphis, TN 38148-3029
Phone (601) 213-3010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009772891 | Medicaid | MS |
Other names
- Ochsner Health Center- Morton
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Morton, MS
- Jamie Renee Rawson
- Ross Dental Clinic P.C.
- Jamie Eichelberger Ross
- Scott County LTC, Inc.
- Scott Regional Medical Center, Inc
- Scott Regional Medical Center, Inc.
- Scott Regional Medical Center, Inc.
- Ashley Murphy Shivers
- Sitting Angels Customized Senior Care
- Daniel M Walker
All providers in Morton, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.