NPIMap

Organization Active NPI

Community Medical Center

  • Rural Health Clinic/Center
  • Lucedale, MS
National Provider Identifier
1194734913
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY MEDICAL CENTER
Practice address
92 W Ratliff Street
Lucedale, MS 39452-6537
Phone
(601) 947-8181
Fax
(601) 947-4411
NPI assigned
Aug 8, 2006
Last updated
Feb 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Authorized official

Name
Ms. Susan Rutledge
Title
Billing Manager
Phone
(601) 947-1330

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Pediatrics Physician 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

92 W Ratliff Street
Lucedale, MS 39452-6537

Mailing address

PO Box 1007
Lucedale, MS 39452-1007
Phone (601) 947-8181

Other identifiers 3

IdentifierTypeStateIssuer
C00960OtherMSMEDICARE CAHABA
09013891MedicaidMS
CN0018OtherMSRAILROAD MEDICARE/OTHER

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040820000647 MS Part B Supplier - Clinic/Group Practice 8921072588 Receives reassigned benefits from 45 practitioners
1 other NPI on this enrollment
Practice locations: Lucedale, MS
O20071119000283 MS Part A Provider - Rural Health Clinic 8921072588 Practice locations: Lucedale, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194734913. Details of each certification follow.

Rural health clinic certification: CCN 253988

Legal name
COMMUNITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1993
Last certification
Mar 31, 2022
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Enrollment address
92 West Ratliff Street
Lucedale, MS 39452-6537
Related CCNs
250036

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

Other NPIs on the same Medicare enrollment 1

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
25D0672385Community Medical Center Lab92 West Ratliff Street, Suite a, Lucedale, MS 39452Certificate of waiverNov 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Medical Cente4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

92 Ratliff St
#A
Lucedale, MS 39452
Phone (601) 947-4411

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBHCBA

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
Jeff Howell Individual Corporate DirectorBoard of Trustees Oct 1, 2007
Janice Steele Individual Corporate OfficerAdministrator Nov 4, 2015
W-2 Managing Employee Nov 4, 2015
Operational/Managerial ControlAdministrator Nov 4, 2015
Wilson Williams Individual Corporate DirectorBoard of Trustees Oct 1, 2007
Margaret Dixon Individual Corporate DirectorBoard of Trustees Jan 1, 2007
George County Hospital Organization, Lucedale, MS For-profit 5% Or Greater Direct Ownership Interest Jul 1, 1993
Operational/Managerial Control Jul 1, 1993
Greg Havard Individual Corporate OfficerCeo Jan 1, 2015
W-2 Managing EmployeeCeo Jan 1, 2015
Operational/Managerial ControlCeo Jan 1, 2015
Robert Langley Individual Corporate DirectorBoard of Trustees Oct 1, 2006
Susan M Rutledge Individual Corporate OfficerBilling Office Manager Oct 1, 2006
W-2 Managing EmployeeBilling Office Manager May 5, 2003

Owners & managing parties with NPI records 2

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

Facilities with the same owner 3

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

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1194734913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1007",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394521007",
            "telephone_number": "601-947-8181",
            "fax_number": "601-947-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 W RATLIFF STREET",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394526537",
            "telephone_number": "601-947-8181",
            "fax_number": "601-947-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "RUTLEDGE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "601-947-1330",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CAHABA",
            "identifier": "C00960",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013891",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE/OTHER",
            "identifier": "CN0018",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lucedale, MS

Sources for this page

Verify at the official NPI Registry.