NPIMap

Organization Active NPI

Laird Hospital, Inc

Doing business as Ochsner Health Center- Collinsville

  • Rural Health Clinic/Center
  • Collinsville, MS
National Provider Identifier
1073959375
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAIRD HOSPITAL, INC
Doing business as
Ochsner Health Center- Collinsville
Practice address
9097 Collinsville Rd
Collinsville, MS 39325-9779
Phone
(601) 626-8874
Fax
(601) 626-8592
NPI assigned
May 14, 2013
Last updated
Apr 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Authorized official

Name
Mr. Don Larkin Kennedy
Title
Regional Ceo
Phone
(601) 703-9614

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

9097 Collinsville Rd
Collinsville, MS 39325-9779

Mailing address

Dept. 3023, PO Box 1000
Memphis, TN 38148-3023
Phone (601) 213-3010

Other identifiers 1

IdentifierTypeStateIssuer
007379233MedicaidMS

Other names 1

  • Ochsner Health Center- Collinsville Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050201000304 MS Part B Supplier - Clinic/Group Practice 7214991769 Receives reassigned benefits from 106 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Collinsville, MS; Union, MS; Philadelphia, MS; Meridian, MS; Newton, MS; Decatur, MS
O20130711000664 MS Part A Provider - Rural Health Clinic 7214991769 Practice locations: Collinsville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073959375. Details of each certification follow.

Rural health clinic certification: CCN 258554

Legal name
LAIRD HOSPITAL, INC.
Doing business as
OCHSNER HEALTH CENTER- COLLINSVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 28, 2009
Last certification
Aug 22, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 3, 2004 in MS
Enrollment address
9097 Collinsville Rd
Collinsville, MS 39325-9779
Related CCNs
251322

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
25D2021672Ochsner Health Center - Collinsville9097 Collinsville Rd, Collinsville, MS 39325Certificate of waiverOct 24, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1500 Highway 19 N
Meridian, MS 39307
Phone (601) 483-5353

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Johnathan Y Lee Individual Corporate DirectorGoverning Board, Rush Health System Jul 1, 2022
Operational/Managerial ControlGoverning Board, Rush Health System Jul 1, 2022
Michael F Hulefeld Individual Corporate OfficerPresident, Coo Nov 1, 2022
Corporate DirectorPresident, Coo Nov 1, 2022
Operational/Managerial ControlPresident, Coo Nov 1, 2022
Faye Martin Individual Corporate DirectorGoverning Board, Rush Health System Jul 1, 2022
Operational/Managerial ControlGoverning Board, Rush Health System Jul 1, 2022
Alan Gartrell Individual Corporate DirectorGoverning Board, Rush Health System Jul 1, 2022
Operational/Managerial ControlGoverning Board, Rush Health System Jul 1, 2022
Peter C November Individual Corporate OfficerChief Executive Officer Nov 1, 2022
Corporate DirectorChief Executive Officer Nov 1, 2022
Operational/Managerial ControlChief Executive Officer Nov 1, 2022
Heather Davis Individual W-2 Managing Employee Jan 1, 2024
Operational/Managerial Control Jan 1, 2024
James M Molloy Individual Corporate Officer Jan 1, 2024
Darrell Wildman Individual Corporate DirectorGoverning Board, Rush Health System Jul 1, 2022
Operational/Managerial ControlGoverning Board, Rush Health System Jul 1, 2022
Ochsner Clinic Foundation Organization, New Orleans, LA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2022 100%
Operational/Managerial Control Jul 1, 2022
Don L Kennedy Individual Corporate OfficerRegional Chief Executive Officer Jul 1, 2022
W-2 Managing EmployeeRegional Chief Executive Officer, R Jul 1, 2022
Operational/Managerial ControlRegional Chief Executive Officer, R Jul 1, 2022
Rush Health Systems Inc Organization, Meridian, MS Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2022 100%
Operational/Managerial Control Jun 1, 2013
David L Butler Individual Corporate OfficerChief Financial Officer, Rush Healt Jan 1, 2020
W-2 Managing EmployeeChief Financial Officer, Rush Healt Jul 1, 2022
Operational/Managerial ControlChief Financial Officer, Rush Healt Jul 1, 2022

Owners & managing parties with NPI records 3

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

Facilities with the same owner 75

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

  • Kemper Cah, Inc

    dba Ochsner Health Center-Hwy 39

    • Rural Health Clinic/Center
    • Meridian, MS
    • NPI 1275879314

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Kemper Cah, Inc.

    dba Ochsner Stennis Hospital Swing Bed

    • Medicare Defined Swing Bed Hospital Unit
    • De Kalb, MS
    • NPI 1518260322

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Kemper Cah, Inc.

    dba Ochsner Stennis Hospital

    • Critical Access Hospital
    • De Kalb, MS
    • NPI 1679875645

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Kemper Cah, Inc.

    dba Ochsner Health Center-Dekalb

    • Rural Health Clinic/Center
    • De Kalb, MS
    • NPI 1912348616

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Kemper, Cah, Inc.

    dba Ochsner Health Center-Marion

    • Rural Health Clinic/Center
    • Marion, MS
    • NPI 1669812962

    Rush Health Systems Inc

    CMS ownership
  • Laird Hospital, Inc.

    dba Ochsner Laird Hospital Swing Bed

    • Medicare Defined Swing Bed Hospital Unit
    • Union, MS
    • NPI 1033176276

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Laird Hospital, Inc.

    dba Ochsner Health Center- Decatur

    • Rural Health Clinic/Center
    • Decatur, MS
    • NPI 1033460878

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Laird Hospital, Inc.

    dba Ochsner Childrens Health Center

    • Rural Health Clinic/Center
    • Meridian, MS
    • NPI 1114330347

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Laird Hospital, Inc.

    dba Ochsner Health Center- Newton

    • Rural Health Clinic/Center
    • Newton, MS
    • NPI 1194323170

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Laird Hospital, Inc.

    dba Ochsner Health Center- Philadelphia

    • Rural Health Clinic/Center
    • Philadelphia, MS
    • NPI 1275873572

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Laird Hospital, Inc.

    dba Ochsner Laird Hospital

    • Critical Access Hospital
    • Union, MS
    • NPI 1518924752

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
  • Laird Hospital, Inc.

    dba Ochsner Health Center- Union

    • Rural Health Clinic/Center
    • Union, MS
    • NPI 1851643928

    Ochsner Clinic Foundation, Rush Health Systems Inc

    CMS ownership
View all 75

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1073959375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT. 3023, PO BOX 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381483023",
            "telephone_number": "601-213-3010",
            "fax_number": "601-213-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9097 COLLINSVILLE RD",
            "city": "COLLINSVILLE",
            "state": "MS",
            "postal_code": "393259779",
            "telephone_number": "601-626-8874",
            "fax_number": "601-626-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAIRD HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-14",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "DON",
        "authorized_official_middle_name": "LARKIN",
        "authorized_official_title_or_position": "REGIONAL CEO",
        "authorized_official_telephone_number": "601-703-9614",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007379233",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ochsner Health Center- Collinsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Collinsville, MS

Sources for this page

Verify at the official NPI Registry.