NPIMap

Organization Active NPI

Anderson Regional Medical Center

Doing business as Baptist Anderson Family Medical Center-Airpark

  • Rural Health Clinic/Center
  • Philadelphia, MS
National Provider Identifier
1053750125
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ANDERSON REGIONAL MEDICAL CENTER
Doing business as
Baptist Anderson Family Medical Center-Airpark
Practice address
1056 Holland Ave
Philadelphia, MS 39350-9121
Phone
(601) 656-8545
Fax
(601) 656-3985
NPI assigned
Jun 21, 2013
Last updated
Aug 16, 2024By the provider in NPPES
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1056 Holland Ave
Philadelphia, MS 39350-9121

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
09014742MedicaidMS

Other names 1

  • Baptist Anderson Family Medical Center-Airpark Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130823000675 MS Part A Provider - Rural Health Clinic 4284548025 Practice locations: Philadelphia, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053750125. Details of each certification follow.

Rural health clinic certification: CCN 258587

Legal name
ANDERSON REGIONAL MEDICAL CENTER
Doing business as
BAPTIST ANDERSON FAMILY MEDICAL CENTER- AIRPARK
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 24, 2013
Last certification
Oct 21, 2021
Ownership / control type
1B
Organization structure
CorporationNon-profit
Enrollment address
1056 Holland Ave
Philadelphia, MS 39350-9121
Related CCNs
250104

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0697513Anderson Family Medical Center - Airpark1056 Holland Ave, Philadelphia, MS 39350Certificate of waiverNov 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Jeff Anderson Reg Med C19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jason M Little Individual Corporate OfficerPresident Bmhcc Jan 1, 2024
Operational/Managerial ControlPresident / Ceo Jan 1, 2024
James Grantham Individual Corporate DirectorBoard Member Jan 1, 2024
Operational/Managerial ControlBoard Member Jan 1, 2024
Wilbur G Wilkinson Individual Corporate OfficerVice Chairman Jan 1, 2022
Corporate DirectorVice Chairman Jan 1, 2024
Operational/Managerial ControlVice Chairman Jan 1, 2024
Joseph M Anderson Individual Corporate OfficerChairman of the Board Jan 1, 2011
Corporate DirectorBoard Member Jan 1, 2011
Operational/Managerial ControlChairman of the Board Jan 1, 2024
David Vowell Individual Corporate Director Feb 1, 2014
Operational/Managerial ControlBoard Member Jan 1, 2024
John G Anderson Individual Corporate OfficerAdministrator Jul 28, 2011
W-2 Managing EmployeeAdministrator Jul 28, 2011
Operational/Managerial ControlAdministrator Jan 1, 2024
Arthur Maples Individual W-2 Managing EmployeeDir. Reg. Planning/Policy @ P Jan 1, 2024
Janet G Farrington Individual Corporate DirectorBoard Member Jan 1, 2011
Operational/Managerial ControlBoard Member Jan 1, 2024
Anderson Regional Medical Center Organization, Meridian, MS Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2011 100%
Gregory M Duckett Individual Corporate OfficerSecretary Jan 1, 2024
Corporate DirectorSecretary Jan 1, 2024
Operational/Managerial ControlSecretary Jan 1, 2024
Kimberly Young Individual Corporate DirectorCorporate Officer Jan 1, 2024
Baptist Memorial Health Care Corporation Organization, Memphis, TN Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
Shawn Shawn Anderson Individual Corporate DirectorBoard Member Jan 1, 2011
Operational/Managerial ControlBoard Member Jan 1, 2024
Brad Huff Individual Corporate DirectorBoard Member Mar 1, 2020
Operational/Managerial ControlBoard Member Jan 1, 2024

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 7

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

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 47

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1053750125",
    "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": "1056 HOLLAND AVE",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393509121",
            "telephone_number": "601-656-8545",
            "fax_number": "601-656-3985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014742",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Anderson Family Medical Center-Airpark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, MS

Sources for this page

Verify at the official NPI Registry.