NPIMap

Organization Active NPI

Jasper General Hospital

Doing business as Pro Care Home Health

  • Home Health Agency
  • Bay Springs, MS
National Provider Identifier
1083715718
Registry record updated Mar 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
5181 Issued in MS
Legal business name
JASPER GENERAL HOSPITAL
Doing business as
Pro Care Home Health
Practice address
20 Bay Ave
Bay Springs, MS 39422-0527
Phone
(601) 764-2081
Fax
(601) 764-9454
NPI assigned
Sep 26, 2006
Organization subpart
Yes
Parent organization
JASPER GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 20, 2017

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

Authorized official

Name
Mrs. Terri J James, R.N.
Title
Billing
Phone
(601) 764-2081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 5181 MS Primary

Addresses

Primary practice location

20 Bay Ave
Bay Springs, MS 39422-0527

Mailing address

PO Box 527
Bay Springs, MS 39422-0527
Phone (601) 764-2081

Other identifiers 4

IdentifierTypeStateIssuer
00070596MedicaidMS
862206OtherMSWELLCARE
5000396OtherMSUNITED HEALTH CARE
000070596OtherMSBLUE CROSS

Other names 1

  • Pro Care Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170316001049 MS Part A Provider - Home Health Agency 1052487105 Practice locations: Bay Springs, MS

Home health agency certification: CCN 257096

Legal name
JASPER GENERAL HOSPITAL
Doing business as
PRO CARE HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 10, 1975
Last certification
Nov 16, 2017
Ownership / control type
Government Operated
Organization structure
OtherNon-profit
Enrollment address
20 Bay Avenue
Bay Springs, MS 39422-0527

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Pro Care Home HealthCCN 257096 · All quality measures
Overall star rating
2.5 of 5
Ownership
Government Operated
Certified
Dec 10, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Jasper General Hospital7 organizations share this tax ID, including this one
Part of
Jasper General Hospital

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Jasper General Hospital Organization, Bay Springs, MS 5% Or Greater Direct Ownership Interest Dec 1, 1975 100%
Terri James Individual W-2 Managing Employee Feb 1, 2017
Griff Kelly Individual Corporate OfficerChief Financial Officer Apr 4, 2018

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Jasper County After Hours ClinicBay Springs, MS, CCN 258643 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2020

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489968000000",
    "number": "1083715718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 527",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394220527",
            "telephone_number": "601-764-2081",
            "fax_number": "601-764-9454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 BAY AVE",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394220527",
            "telephone_number": "601-764-2081",
            "fax_number": "601-764-9454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASPER GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JASPER GENERAL HOSPITAL",
        "enumeration_date": "2006-09-26",
        "last_updated": "2017-03-20",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "601-764-2081",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MS",
            "license": "5181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00070596",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "862206",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "5000396",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000070596",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro Care Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bay Springs, MS

Sources for this page

Verify at the official NPI Registry.