NPIMap

Organization Active NPI

Boa Vida Hospital of Aberdeen, Ms, LLC

  • Rural Health Clinic/Center
  • Columbus, MS
National Provider Identifier
1124515515
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC
Practice address
2200 5TH St N
Columbus, MS 39705-2212
Phone
(662) 369-2455
NPI assigned
Apr 20, 2018
Last updated
Oct 26, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BOA VIDA HOSPITAL OF ABERDEEN, MS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Authorized official

Name
Dr. Kirnjot Singh
Title
President
Phone
(219) 228-4355

Specialties & licenses 1

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

Addresses

Primary practice location

2200 5TH St N
Columbus, MS 39705-2212

Mailing address

10996 Four Seasons PL Ste 100C
Crown Point, IN 46307-7762
Phone (219) 228-1021

Other names 1

  • MRH Medical Group, Columbus 5th St Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180702000070 MS Part A Provider - Rural Health Clinic 0244505840 Practice locations: Columbus, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124515515. Details of each certification follow.

Rural health clinic certification: CCN 258635

Legal name
BOA VIDA HOSPITAL OF ABERDEEN MS LLC
Doing business as
MRH MEDICAL GROUP, COLUMBUS 5TH ST.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 8, 2019
Last certification
Oct 8, 2019
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
2200 5TH St N
Columbus, MS 39705-2212
Related CCNs
251302

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

National Provider Directory

National Provider Directory
Tax ID family
Boa Vida Hospital Aberdeen36 organizations share this tax ID, including this one
Part of
Boa Vida Hospital Aberdeen

Other organizations with this tax ID 35

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

View all 35

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
Boa Vida Hospital of Aberdeen Ms LLC Organization, Aberdeen, MS Created for acquisition, LLC, For-profit 5% Or Greater Direct Ownership Interest Oct 1, 2017 99%
Jennie Lankhorst Individual W-2 Managing EmployeeDirector, Payor Contracting & Crede Apr 20, 2024
Kirnjot Singh Individual Corporate OfficerPresident Oct 1, 2017 100%
W-2 Managing EmployeePresident Oct 1, 2017 100%

All facility ownership & control disclosures 23

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

FacilityTypeRoleSince
Monroe Regional HospitalAberdeen, MS, CCN 251302 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2017
Oct 1, 2017
Monroe Regional HospitalAberdeen, MS, CCN 25Z302 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2017
Oct 1, 2017
Monroe Regional HospitalAberdeen, MS, CCN 25M302 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017
MRH Medical Group JurneyAberdeen, MS, CCN 258537 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017
Monroe Regional HospitalAberdeen, MS, CCN 258975 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017
MRH Medical GroupAberdeen, MS, CCN 258515 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2017
Oct 1, 2017
MRH Medical Group HamiltonHamilton, MS, CCN 258521 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2017
Oct 1, 2017
Monroe Regional HospitalSherman, MS, CCN 258647 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
Monroe Regional HospitalAmory, MS, CCN 258634 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group, Primary Care and Women's WellnessColumbus, MS, CCN 258633 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2017
Oct 1, 2017
MRH Medical Group, West PointWest Point, MS, CCN 258638 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2017
MRH Medical Group, Corinth Alcorn Dr.Corinth, MS, CCN 258639 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2017
MRH Medical Group, NettletonNettleton, MS, CCN 258636 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group, BelmontBelmont, MS, CCN 258637 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017
MRH Medical Group, GSV HoulkaNew Houlka, MS, CCN 258646 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
Monroe Regional HospitalPontotoc, MS, CCN 258657 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group East Main Family MedicalTupelo, MS, CCN 258658 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group Premier Diabetes and Medical ClinicBelden, MS, CCN 258656 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group, StarkvilleStarkville, MS, CCN 258666 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group, Verona Family Medicine & Urgent CareTupelo, MS, CCN 258659 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group Potter Family ClinicGreenville, MS, CCN 258668 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2017
MRH Medical Group Horn Medical ClinicHouston, MS, CCN 258667 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017
MRH Medical Group Rice Family Medical ClinicCalhoun City, MS, CCN 258669 Rural health clinic 5% Or Greater Direct Ownership Interest (99%) Oct 1, 2017

Facilities with the same owner 23

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

View all 23

Practitioners & affiliated clinicians

Practitioners 6

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": "1524182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1124515515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10996 FOUR SEASONS PL STE 100C",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077762",
            "telephone_number": "219-228-1021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052212",
            "telephone_number": "662-369-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC",
        "enumeration_date": "2018-04-20",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "SINGH",
        "authorized_official_first_name": "KIRNJOT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-228-4355",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MRH Medical Group, Columbus 5th St",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Columbus, MS

Sources for this page

Verify at the official NPI Registry.