NPIMap

Organization Active NPI

Anderson Regional Medical Center

  • Specialist
  • Meridian, MS
National Provider Identifier
1043764699
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ANDERSON REGIONAL MEDICAL CENTER
Practice address
2124 14TH St
Meridian, MS 39301-4040
Phone
(601) 553-6000
Fax
(601) 703-0124
NPI assigned
Aug 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gregory M Duckett
Title
Sr VP / Clo
Phone
(901) 227-5233

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X

Addresses

Primary practice location

2124 14TH St
Meridian, MS 39301-4040

Mailing address

2124 14TH St
Meridian, MS 39301-4040
Phone (601) 703-3480

Other practice location 1

2111 14th Street
Meridian, MS 39301
Phone (601) 693-3834

Other practice location 2

2024 15th Street, 5th Floor, Medical Tower I
Meridian, MS 39301-4100
Phone (601) 553-6399

Other practice location 3

1704 23rd Ave
Meridian, MS 39301-3103
Phone (601) 485-5081

Other practice location 4

2024 15th Street, 4th Floor, Suite 3
Meridian, MS 39301
Phone (601) 553-6000

Other identifiers 2

IdentifierTypeStateIssuer
008874574MedicaidMS
205173MedicaidAL

Other names 1

  • Baptist Anderson Professional Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170405001138 MS Part B Supplier - Clinic/Group Practice 4284548025 Receives reassigned benefits from 31 practitioners
Practice locations: Meridian, MS

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1704 23rd Ave
Meridian, MS 39301
Phone (601) 485-5081

2024 15th St
Fl 3
Meridian, MS 39301
Phone (601) 553-2000

1523 22nd Ave
#B
Meridian, MS 39301
Phone (601) 483-0039

1056 Holland Ave
Philadelphia, MS 39350
Phone (601) 656-1465

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anderson Regional Medical CenterMeridian, MS, CCN 250104 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 2024
Baptist Anderson Regional Medical Center - SouthMeridian, MS, CCN 250081 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Baptist Anderson Tom C. Maynor Rehabilitation CenterMeridian, MS, CCN 25T081 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Baptist Anderson Senior Behavioral Health CenterMeridian, MS, CCN 25S081 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2011
Jan 1, 2001
Baptist Anderson Swing Bed UnitMeridian, MS, CCN 25U081 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2011
Baptist Anderson Family Medical Center- EnterpriseEnterprise, MS, CCN 258588 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2011
Jan 1, 2011
Baptist Anderson Children'S Medical CenterMeridian, MS, CCN 258584 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2011
Baptist Anderson Family Medical Center- AirparkPhiladelphia, MS, CCN 258587 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2011

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 68

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 68

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1043764699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 14TH ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014040",
            "telephone_number": "601-703-3480",
            "fax_number": "601-703-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 14TH ST",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393014040",
            "telephone_number": "601-553-6000",
            "fax_number": "601-703-0124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2111 14th Street",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "39301",
            "country_code": "US",
            "telephone_number": "601-693-3834",
            "fax_number": "601-484-3225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2024 15th Street, 5th Floor, Medical Tower I",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393014100",
            "country_code": "US",
            "telephone_number": "601-553-6399",
            "fax_number": "601-703-8398",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1704 23rd Ave",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393013103",
            "country_code": "US",
            "telephone_number": "601-485-5081",
            "fax_number": "601-485-5084",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2024 15th Street, 4th Floor, Suite 3",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "39301",
            "country_code": "US",
            "telephone_number": "601-553-6000",
            "fax_number": "601-703-0124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANDERSON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-12",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VP / CLO",
        "authorized_official_telephone_number": "901-227-5233"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008874574",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205173",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Anderson Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.