NPIMap

Organization Active NPI

Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
National Provider Identifier
1194789818
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
13318 Issued in MS
Legal business name
BAPTIST MEMORIAL HOSPITAL-DESOTO, INC,
Practice address
7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone
(662) 349-4000
NPI assigned
Apr 12, 2006
Last updated
Apr 12, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
General Acute Care Hospital 282N00000X 13318 MS Primary

Addresses

Primary practice location

7601 Southcrest Pkwy
Southaven, MS 38671-4739

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177
Phone (662) 349-4000

Other identifiers 3

IdentifierTypeStateIssuer
00020143MedicaidMS
114992105MedicaidAR
250141MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040405001337 MS Part B Supplier - Clinic/Group Practice 5597758755 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
Practice locations: Southaven, MS
O20080618000185 MS Part A Provider - Hospital 5597758755 Practice locations: Southaven, MS
O20181126000054 MS Part B Supplier - Intensive Cardiac Rehabilitation 5597758755 Practice locations: Southaven, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194789818. Details of each certification follow.

Hospital certification: CCN 250141

Legal name
BAPTIST MEMORIAL HOSPITAL-DESOTO, INC.
Doing business as
BMH - DESOTO
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 19, 1988
Last certification
Feb 5, 2021
Beds
161 (131 certified)
Ownership / control type
Private (for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1982 in MS
Enrollment address
7601 Southcrest Parkway
Southaven, MS 38671-4739
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Baptist Memorial Hospital DesotoCCN 250141 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Baptist Memorial Hospital4 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.

Locations

7601 Southcrest Pkwy
Southaven, MS 38671
Phone (662) 349-4000

7900 Airways Blvd
Southaven, MS 38671
Phone (662) 349-3011

Ownership & related parties

All disclosed owners & managing parties 13

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 OfficerVP Jan 14, 2013
Spence Wilson Individual Corporate DirectorBoard Member Jan 1, 2005
Cary M. Finn Individual Corporate DirectorBoard Member Aug 20, 2020
Arthur Maples Individual Corporate DirectorDelegated Official Dec 15, 2020
Paul Duane Depriest Individual Corporate Officer Jun 1, 2014
Arie Szatkowski Individual Corporate DirectorBoard Member Aug 20, 2020
Gregory M Duckett Individual Corporate OfficerCorp Sec Jan 1, 2000
Dale L Morris Individual Corporate Director Jan 1, 2015
William Griffin Individual Corporate OfficerEvp Cfo Dec 15, 2020
Riad I Homsi Individual Corporate DirectorBoard Member Aug 20, 2020
Brian Hogan Individual W-2 Managing EmployeeManaging Employee Aug 20, 2020
Baptist Memorial Health Care Corporation Organization, Memphis, TN Non-profit 5% Or Greater Direct Ownership Interest Aug 25, 1982
Randy King Individual Corporate Officer Jan 1, 2015

Owners & managing parties with NPI records 4

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 122

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 122

Affiliated clinicians 754

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 754

NPI Registry JSON

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1194789818",
    "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",
            "telephone_number": "662-349-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 SOUTHCREST PKWY",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714739",
            "telephone_number": "662-349-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEMORIAL HOSPITAL-DESOTO, INC,",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2006-04-12",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MS",
            "license": "13318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020143",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114992105",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250141",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.