Boa Vida Hospital of Aberdeen, Ms, LLC
Organization Active NPI Rural Health Clinic/Center · Columbus, MS
NPI 1124515515 · NPPES record last updated Oct 26, 2023
Key facts
- NPI
- 1124515515
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- Yes
- Parent organization (as reported)
- BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC
Authorized official
- Name
- Dr. Kirnjot Singh
- Title
- President
- Phone
- (219) 228-4355
Corporate family (same tax ID) 35
Related certifications (CCN) 1
Facilities with the same owner 23
Practitioners 6
-
Lauren M Barrier, FNP
-
Samuel Keith Box, D.O.
-
Amanda Everett, NP-C
-
Raymond G Overstreet, M.D.
-
Candace R. Murbach, D.O.
-
Robert M. Pallay, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
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
- LLC · Proprietary
- Enrollment address
- 2200 5TH St N
Columbus, MS 39705-2212 - Related CCNs
- 251302
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Boa Vida Hospital of Aberdeen Ms LLC |
5% Or Greater Direct Ownership Interest | Oct 1, 2017 | 99% |
| Jennie Lankhorst |
W-2 Managing Employee |
Apr 20, 2024 | |
| Kirnjot Singh |
Corporate Officer |
Oct 1, 2017 | 100% |
| W-2 Managing Employee |
Oct 1, 2017 | 100% |
All facility ownership & control disclosures 23
| Facility | Type | Role | Since |
|---|---|---|---|
| Monroe Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2017 Oct 1, 2017 |
| Monroe Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2017 Oct 1, 2017 |
| Monroe Regional Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2017 |
| MRH Medical Group Jurney |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2017 |
| Monroe Regional Hospital |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2017 |
| MRH Medical Group |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2017 Oct 1, 2017 |
| MRH Medical Group Hamilton |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2017 Oct 1, 2017 |
| Monroe Regional Hospital |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| Monroe Regional Hospital |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group, Primary Care and Women'S Wellness |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2017 Oct 1, 2017 |
| MRH Medical Group, West Point |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Oct 1, 2017 |
| MRH Medical Group, Corinth Alcorn Dr. |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Oct 1, 2017 |
| MRH Medical Group, Nettleton |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group, Belmont |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2017 |
| MRH Medical Group, GSV Houlka |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| Monroe Regional Hospital |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group East Main Family Medical |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group Premier Diabetes and Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group, Starkville |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group, Verona Family Medicine & Urgent Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group Potter Family Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 2017 |
| MRH Medical Group Horn Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
| MRH Medical Group Rice Family Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (99%) | Oct 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180702000070 | MS | Part a Provider - Rural Health Clinic | 0244505840 | Practice locations: Columbus, MS |
National Provider Directory
- Tax ID family
- Boa Vida Hospital Aberdeen
- Part of
- Boa Vida Hospital Aberdeen
Locations
2200 5th St N
Columbus, MS 39705
Phone (662) 369-2455
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- MRH Medical Group, Columbus 5th St
Other providers in Columbus, MS
- Shanta Blakney
- Blue Marble Mobility, LLC
- Keirra Sheree Blunt
- Kelli Blunt
- Boa Vida Hospital of Aberdeen, Ms LLC
- Boa Vida Hospital of Aberdeen, Ms, LLC
- Courtney Carter Boatright
- Dawn Boggan
- Joseph S Boggess
- Lois Boggess
All providers in Columbus, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.