NPIMap

Organization Active NPI

Baptist Memorial Hospital - Calhoun, Inc

  • Rural Health Clinic/Center
  • Calhoun City, MS
National Provider Identifier
1174043632
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAPTIST MEMORIAL HOSPITAL - CALHOUN, INC
Practice address
112 Medical Arts Dr
Calhoun City, MS 38916-9721
Phone
(662) 628-1274
NPI assigned
Jun 26, 2017
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
Gregory M Duckett
Title
Sr VP/Clo
Phone
(901) 227-5233

Specialties & licenses 1

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

Addresses

Primary practice location

112 Medical Arts Dr
Calhoun City, MS 38916-9721

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177

Other names 2

  • BMH Calhoun Doing business as
  • Baptist Calhoun Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161203000022 MS Part B Supplier - Clinic/Group Practice 5395024210 Receives reassigned benefits from 31 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Calhoun City, MS
O20170817000052 MS Part A Provider - Rural Health Clinic 5395024210 Practice locations: Calhoun City, MS

Rural health clinic certification: CCN 258628

Legal name
BAPTIST MEMORIAL HOSPITAL - CALHOUN INC
Doing business as
BAPTIST CALHOUN RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 6, 2018
Last certification
Feb 6, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 28, 2016 in MS
Enrollment address
112 Medical Arts Dr
Calhoun City, MS 38916-9721
Related CCNs
251331

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
25D2118550Baptist Memorial Hospital - Calhoun, Inc112 Medical Arts Drive, Calhoun City, MS 38916Certificate of waiverNov 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Baptist Memorial Hospital-Calhoun Inc4 organizations share this tax ID, including this one
Part of
Baptist Memorial Health Care Corp

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jason M Little Individual Corporate Officer Sep 1, 2017
Tom Longest Individual Corporate Director Sep 1, 2017
Rita Box Individual Corporate Director Jan 1, 2024
Gary C Anderson Individual Corporate Director Jan 1, 2024
Arthur Maples Individual Corporate DirectorDelegated Official Sep 1, 2017
W-2 Managing Employee Jan 1, 2000
Christopher Threadgill Individual Corporate OfficerCeo Dec 11, 2020
W-2 Managing EmployeeCeo Dec 11, 2020
Roy McDowell Individual Corporate Director Sep 1, 2017
Gregory M Duckett Individual Corporate Officer Sep 1, 2017
Kimberly Young Individual W-2 Managing EmployeeCfo Jan 1, 2024
Lee Peden Individual Corporate Director Sep 1, 2017
Shelia Freely Individual Corporate Director Sep 1, 2017
Rita Talford Individual Corporate Director Sep 1, 2017
Baptist Memorial Health Care Corporation Organization, Memphis, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2017 100%
Terry Miller Individual Corporate Director Sep 1, 2017

Owners & managing parties with NPI records 1

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

Facilities with the same owner 47

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

View all 47

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1174043632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MEDICAL ARTS DR",
            "city": "CALHOUN CITY",
            "state": "MS",
            "postal_code": "389169721",
            "telephone_number": "662-628-1274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEMORIAL HOSPITAL - CALHOUN, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2017-06-26",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VP/CLO",
        "authorized_official_telephone_number": "901-227-5233"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMH Calhoun",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baptist Calhoun Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baptist Calhoun Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Calhoun City, MS

Sources for this page

Verify at the official NPI Registry.