North Mississippi Medical Center, Inc.
Organization Active NPI Home Health Agency · Tupelo, MS
NPI 1003871344 · NPPES record last updated Oct 8, 2019
Key facts
- NPI
- 1003871344
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 8481 (MS)
- Legal business name
- NORTH MISSISSIPPI MEDICAL CENTER, INC.
- Practice address
- 424 East President Street
Tupelo, MS 38801-5500 - Phone
- (662) 377-2138
- Fax
- (662) 377-7983
- NPI assigned
- Apr 19, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- NORTH MISSISSIPPI MEDICAL CENTER, INC.
Authorized official
- Name
- Mr. Joseph A Reppert
- Title
- Cfo
- Phone
- (662) 377-3978
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 12
Facilities with the same owner 33
Practitioners 361
-
Haritha Abbott, CRNA
-
Patrick Ward Abel, CRNA
-
Becky A Adams, CRNA
-
Emad Alghazo, MD
-
Haya Alghazo, MD
-
Sonja Bain Armstrong, CRNA
-
Richard Michael Arriola, M.D.
-
Sarah Cotton Ashmore, CRNA
-
Amanda H Bagwell, CRNA
-
James Lee Baker, M.S.N.
-
Tracey S Baker, CRNA
-
Keven L. Barber, CRNA
-
Marianne Barnes, MD
-
Vernon W. Barrow III, M.D.
-
Mylie Kate Beane, FNP-C
-
Robert Conrad Becker, M.D.
-
William Scot Bell, M.D.
-
Michael R Benge, CRNA
Affiliated clinicians 213
-
Kevin William Abel, M.D.
-
Haya Alghazo, MD
-
Laquita Gay Bain, FNP
-
Thomas Ford Barkley, M.D.
-
Bonnie N. Basler, MD
-
Kirsten J Bolton, M.D.
-
David G Booth, DO
-
Michelle Gardner Briley, FNP-C
-
Jeff T Brown, DO
-
Julian Arthur Brown Jr., M. D.
-
Farris Burns, FNP-C
-
Donna Cannon, FNP-C
-
Andrea Carpenter, FNP-C
-
Whitney Johnson Carroll, FNP-BC
-
Lakeisha Renae Chism, M.D.
-
Caitlin Clark, M.D.
-
Ethan Collier, MD
Medicare Care Compare: Home health agency
- Listed as
- North Mississippi Medical Ctr HHA
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Non-Profit
- Certified
- Jul 1, 1966
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Home health agency certification: CCN 257002
- Legal name
- NORTH MISSISSIPPI MEDICAL CENTER, INC.
- Doing business as
- NORTH MS MEDICAL CENTER HOME HEALTH AGENCY
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jul 1, 1966
- Last certification
- Nov 29, 2017
- Ownership / control type
- Non-Profit
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 2, 1982 in DE
- Enrollment address
- 424 East President Street
Tupelo, MS 38801
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Barry D Bertolet |
Corporate Director |
Oct 1, 2021 | |
| Calude Waycaster |
Corporate Director |
Oct 1, 2021 | |
| William H Milam |
Corporate Director | Jul 1, 1966 | |
| North Mississippi Health Services Inc |
5% Or Greater Direct Ownership Interest | Jul 1, 1966 | |
| Bruce J Toppin |
Corporate Officer | Jul 1, 1966 | |
| Lewis Whitfield |
Corporate Director |
Oct 1, 2021 | |
| Sharon D Nobles |
Corporate Officer |
Apr 4, 2017 | |
| Samuel Jeffery Sliman |
Corporate Director |
Oct 1, 2021 | |
| Samuel C Pace |
Corporate Director |
Oct 1, 2021 | |
| Michael S Spees |
Corporate Director |
Feb 1, 2014 | |
| John Wheeler |
Corporate Director |
Oct 1, 2021 | |
| Gary Lynn Sparkman |
Corporate Director |
Oct 1, 2021 | |
| Chris Rogers |
Corporate Director | Jul 1, 1966 | |
| David Copenhaver |
Corporate Director |
Oct 1, 2021 | |
| Chester K White |
Corporate Director |
Oct 1, 2021 | |
| David Wilson |
W-2 Managing Employee |
Mar 30, 2015 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Baldwyn Nursing Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Mar 16, 2009 Mar 16, 2009 Mar 16, 2009 |
| Childrens Clinic - Tupelo |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) | Aug 24, 1992 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071120000184 | MS | Part a Provider - Home Health Agency | 9931010600 | Practice locations: Tupelo, MS |
National Provider Directory
- Tax ID family
- Anant Shenoy MD
- Part of
- Anant Shenoy MD
Locations
424 E President Ave
Tupelo, MS 38801
Phone (662) 205-4375
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 8481 | MS | Yes |
Addresses
Primary practice location
424 East President Street
Tupelo, MS 38801-5500
Mailing address
830 S Gloster St
Tupelo, MS 38801-4934
Phone (662) 377-2138
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000070519 | Other | MS | BLUE CROSS |
| 00070519 | Medicaid | MS |
Other names
- North MS Medical Center Home Health Agency
Other providers in Tupelo, MS
- North Mississippi Medical Center Services LLC
- North Mississippi Medical Center Services, LLC
- North Mississippi Medical Center, Inc
- North Mississippi Medical Center, Inc
- North Mississippi Medical Center, Inc
- North Mississippi Medical Center, Inc.
- North Mississippi Medical Center, Inc.
- North Mississippi Medical Center, Inc.
- North Mississippi Medical Center, Inc.
- North Mississippi Medical Center, Inc.
All providers in Tupelo, MS · Home Health Agency in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2019. 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.