NPIMap

Organization Active NPI

Covington County Hospital

Doing business as CCH Clinic Seminary

  • Rural Health Clinic/Center
  • Seminary, MS
National Provider Identifier
1134435498
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COVINGTON COUNTY HOSPITAL
Doing business as
CCH Clinic Seminary
Practice address
104 W Main St
Seminary, MS 39479-9027
Phone
(601) 722-3610
Fax
(601) 722-9985
NPI assigned
Aug 25, 2010
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Anissa L Evans
Title
Credentials
Phone
(601) 698-0328

Specialties & licenses 1

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

Addresses

Primary practice location

104 W Main St
Seminary, MS 39479-9027

Mailing address

PO Box 2499
Collins, MS 39428-2499
Phone (601) 722-3610

Other names 1

  • CCH Clinic Seminary Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110413000929 MS Part B Supplier - Clinic/Group Practice 4183517253 Receives reassigned benefits from 26 practitioners
Practice locations: Seminary, MS
O20111122000932 MS Part A Provider - Rural Health Clinic 4183517253 Practice locations: Seminary, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134435498. Details of each certification follow.

Rural health clinic certification: CCN 258561

Legal name
COVINGTON COUNTY HOSPITAL
Doing business as
FAMILY CARE OF SEMINARY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 23, 2012
Last certification
Jun 5, 2019
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1951 in MS
Enrollment address
104 W Main St, Ste 20
Family Care of Seminary
Seminary, MS 39479-9027
Related CCNs
251325

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

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
25D2031642Family Care of Seminary104 W Main Street, Seminary, MS 39479Provider-performed microscopyOct 23, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Greg Sanford Individual Corporate DirectorBoard Member Jan 5, 2008 100%
James McPhail Individual Corporate DirectorBoard Member Jan 15, 2009 100%
Charlie Anglin Individual Corporate DirectorBoard Member Oct 8, 2007 100%
Robert Johnson Individual Corporate DirectorBoard Persident Jan 23, 2007 100%
Greg Sullivan Individual Corporate DirectorBoard Member Oct 8, 2007 100%
Missy L Gamber Individual Contracted Managing EmployeeDirector of Credentialing Aug 1, 2014 100%
Gregg Gibbes Individual Corporate OfficerCeo Apr 28, 2016 100%
W-2 Managing EmployeeCeo Apr 28, 2016 100%
Operational/Managerial ControlCeo Apr 28, 2016 100%
Everlean Booth Individual Corporate DirectorBoard Secretary Nov 18, 2005 100%

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Covington County HospitalCollins, MS, CCN 25M325 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2016
Arrington Living CenterCollins, MS, CCN 255331 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2011
May 1, 2011
Family Medical AssociatesCollins, MS, CCN 253497 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2016
Family Care ExpressCollins, MS, CCN 258562 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2016
Jan 1, 2016
CCH Clinic MageeMagee, MS, CCN 258597 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 2018
Mar 1, 2018
Express Care SumrallSumrall, MS, CCN 258644 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Family Care of MageeMagee, MS, CCN 258662 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 4, 2021
Jan 4, 2021
Family Care Magee Tuscan TowersMagee, MS, CCN 258660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 1, 2021
Sep 1, 2021

Owned or controlled facilities with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1282694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1134435498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2499",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394282499",
            "telephone_number": "601-722-3610",
            "fax_number": "601-722-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W MAIN ST",
            "city": "SEMINARY",
            "state": "MS",
            "postal_code": "394799027",
            "telephone_number": "601-722-3610",
            "fax_number": "601-722-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-25",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ANISSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALS",
        "authorized_official_telephone_number": "601-698-0328"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCH Clinic Seminary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seminary, MS

Sources for this page

Verify at the official NPI Registry.