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State of Mississippi - University of Mississippi Medical Center

Organization Active NPI Rural Health Clinic/Center · West, MS

NPI 1194738393 · NPPES record last updated May 8, 2020

Key facts

NPI
1194738393
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Practice address
18295 Emory Road
West, MS 39192-0000
Phone
(662) 834-1321
Fax
(601) 815-6301
NPI assigned
Aug 15, 2006
Organization subpart
No

Authorized official

Name
Jeffrey Grimsley
Title
Chief Financial Officer
Phone
(601) 815-8732

Owners & managing parties with NPI records 22

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

Owned or controlled facilities with NPI records 15

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

Other NPIs on the same Medicare enrollment 15

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

Other NPIs with the same Medicare PAC ID 22

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

Facilities with the same owner 14

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

Practitioners 959

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

View all 959

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Rural health clinic certification: CCN 253812

Legal name
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Doing business as
WEST RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2009
Last certification
Mar 2, 2022
Ownership / control type
2B
Organization structure
Government · Non-profit
Enrollment address
18295 Emory Rd
West, MS 39192-8388

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Jeffrey G Grimsley
Individual 		Corporate Officer
Cfo		 Jan 1, 2022
W-2 Managing Employee
Cfo		 Sep 1, 2014
State of Mississippi-University of Mississippi Medical Center
Organization · Jackson, MS 		5% Or Greater Direct Ownership Interest May 22, 2013

All facility ownership & control disclosures 14

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

FacilityTypeRoleSince
State of Mississippi-University of Mississippi Medical Center
Jackson, MS · CCN 250001		 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2007
Jul 1, 2007
University of Mississi Medical Center- Holmes County
Lexington, MS · CCN 25Z319		 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2004
Holmes County Hospital & Clinics
Lexington, MS · CCN 251319		 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2004
Ummc- Grenada
Grenada, MS · CCN 250168		 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 21, 2014
Feb 21, 2014
Ummc Madison
Canton, MS · CCN 250038		 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Ummc Madison
Canton, MS · CCN 25U038		 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Lexington Rural Health Clinic
Lexington, MS · CCN 253813		 Rural health clinic 5% Or Greater Direct Ownership Interest May 23, 2013
Ummc- Grenada Women'S Services
Grenada, MS · CCN 258626		 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Holmes County Family Medicine Clinic- Vaiden
Vaiden, MS · CCN 258625		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2016
Ummc Grenada Specialty Pediatrics
Grenada, MS · CCN 258627		 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Children'S of Mississippi Greenwood Clinic
Greenwood, MS · CCN 258682		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Primary Care Clinic
Greenwood, MS · CCN 258679		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Women'S Clinic
Greenwood, MS · CCN 258680		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Grenada Primary Medicine Clinic
Grenada, MS · CCN 258681		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080701000131 MS Part a Provider - Rural Health Clinic 1850293036 Practice locations: West, MS
O20090414000575 MS Part B Supplier - Clinic/Group Practice 1850293036 Receives reassigned benefits from 1,922 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Specialties & licenses

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

Addresses

Primary practice location

18295 Emory Road
West, MS 39192-0000

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (662) 834-1321

Other identifiers

IdentifierTypeStateIssuer
09016279MedicaidMS

Other names

  • Holmes Family Medical Clinic Doing business as

Other providers in West, MS

All providers in West, MS · Rural Health Clinic/Center in Mississippi

Sources for this page

Verify at the official NPI Registry.