NPIMap

Organization Active NPI

South Central Regional Medical Center

Doing business as ComfortCare Home Health

  • Home Health Agency
  • Laurel, MS
National Provider Identifier
1093790404
Registry record updated Jun 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
4081 Issued in MS
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Doing business as
ComfortCare Home Health
Practice address
2260 US Highway 15 North
Laurel, MS 39440-1521
Phone
(601) 425-7521
Fax
(601) 399-6274
NPI assigned
Dec 8, 2005
Last updated
Jun 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2014

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

Authorized official

Name
Mr. James T Canizaro
Title
Vice President/ Cfo
Phone
(601) 399-6139

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 4081 MS Primary

Addresses

Primary practice location

2260 US Highway 15 North
Laurel, MS 39440-1521

Mailing address

PO Box 607
Laurel, MS 39441-0607
Phone (601) 425-7521

Other identifiers 2

IdentifierTypeStateIssuer
000070006OtherMSBCBS HOME HEALTH AGENCY
00070526MedicaidMS

Other names 1

  • ComfortCare 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
O20071214000362 MS Part A Provider - Home Health Agency 8325946411 Practice locations: Laurel, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093790404. Details of each certification follow.

Home health agency certification: CCN 257099

Legal name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Doing business as
COMFORT CARE HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 20, 1976
Last certification
Sep 18, 2018
Ownership / control type
Government Operated
Organization structure
GovernmentNon-profit
Enrollment address
2260 Highway 15 N
Laurel, MS 39440-1833

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Comfortcare Home HealthCCN 257099 · All quality measures
Overall star rating
2.5 of 5
Ownership
Government Operated
Certified
Apr 20, 1976
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
South Central Regional Medical Ctr27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

2260 Highway 15 N
Laurel, MS 39440
Phone (601) 422-0054

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Judith Hicks Individual W-2 Managing EmployeeRevenue Cycle Analyst Jul 25, 1975 1%
South Central Regional Medical Center Organization, Laurel, MS Non-profit Operational/Managerial Control Jul 1, 1991 100%
Gregg Gibbes Individual Corporate OfficerPresident and Ceo Jul 1, 2023 95%
James Canizaro Individual Corporate OfficerCfo Aug 27, 1993 80%
Corporate DirectorCfo Aug 27, 1993 80%
W-2 Managing EmployeeCfo Aug 27, 1993 80%

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Jones County Rest HomeEllisville, MS, CCN 255336 Skilled nursing facility Operational/Managerial Control (100%) Apr 10, 2010
Comfort Care Nursing CenterLaurel, MS, CCN 255352 Skilled nursing facility Operational/Managerial Control (100%) Aug 1, 1994
Comfort Care HospiceLaurel, MS, CCN 251512 Hospice Operational/Managerial Control (100%) Jul 18, 1992
South Central Family Medicine & Urgent CareLaurel, MS, CCN 258581 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2014
South Central PediatricsLaurel, MS, CCN 258510 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 14, 2012
Ellisville Pediatric ClinicEllisville, MS, CCN 253437 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 14, 2012
South Central Primary Care ServicesLaurel, MS, CCN 258649 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2020
South Central Urgent CareLaurel, MS, CCN 258688 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 2020
Jul 1, 2025

Owned or controlled facilities with NPI records 8

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

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Affiliated clinicians 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1093790404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410607",
            "telephone_number": "601-425-7521",
            "fax_number": "601-399-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 US HIGHWAY 15 NORTH",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394401521",
            "telephone_number": "601-425-7521",
            "fax_number": "601-399-6274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-08",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "CANIZARO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT/ CFO",
        "authorized_official_telephone_number": "601-399-6139",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MS",
            "license": "4081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOME HEALTH AGENCY",
            "identifier": "000070006",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00070526",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ComfortCare Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.