NPIMap

Organization Active NPI

Baptist Medical Center-Leake, Inc.

  • Rural Health Clinic/Center
  • Carthage, MS
National Provider Identifier
1194861260
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
11187 Issued in MS
Legal business name
BAPTIST MEDICAL CENTER-LEAKE, INC.
Practice address
1100 Hwy 16 East
Carthage, MS 39051-3809
Phone
(601) 267-1470
Fax
(601) 267-1469
NPI assigned
Jan 29, 2007
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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 11187 MS Primary

Addresses

Primary practice location

1100 Hwy 16 East
Carthage, MS 39051-3809

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177
Phone (601) 267-1470

Other identifiers 1

IdentifierTypeStateIssuer
09016232MedicaidMS

Other names 1

  • BMC Leake Carthage Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111208000595 MS Part A Provider - Rural Health Clinic 7214102961 Practice locations: Carthage, MS
O20120112000444 MS Part B Supplier - Clinic/Group Practice 7214102961 Receives reassigned benefits from 29 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carthage, MS; Madden, MS; Walnut Grove, MS

Rural health clinic certification: CCN 258508

Legal name
BAPTIST MEDICAL CENTER-LEAKE, INC.
Doing business as
BMC LEAKE CARTHAGE PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 17, 2003
Last certification
Dec 9, 2021
Ownership / control type
2B
Most recent change of ownership
Nov 1, 2011 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 2011 in MS
Enrollment address
1100 Highway 16 E
Carthage, MS 39051-4222
Related CCNs
251315

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Baptist Memorial Health Care Corp

Locations

302 Ellis St
Carthage, MS 39051
Phone (601) 267-1100

303 W Franklin St
Carthage, MS 39051
Phone (601) 267-9658

305 Ellis St
Carthage, MS 39051
Phone (601) 267-3241

600 Highway 16 E
Carthage, MS 39051
Phone (601) 267-1480

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 OfficerPresident Dec 10, 2020
Corporate DirectorBoard Member Dec 10, 2020
Arthur Maples Individual Corporate Director Jan 1, 2019
Daryl W Weaver Individual W-2 Managing EmployeeCeo Jan 5, 2015
Arthur Jernigan Individual Corporate DirectorBoard Member Jan 1, 2019
Gregory M Duckett Individual Corporate OfficerSr VP/Clo May 1, 2017
Mikki Ogletree Individual Corporate DirectorBoard Member Dec 10, 2020
Baptist Medical Center-Leake, Inc. Organization, Carthage, MS Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2011
Kimberly Young Individual W-2 Managing EmployeeCfo Jan 1, 2024
Jeff Webb Individual Corporate DirectorBoard Member Jan 1, 2019
Marcus Mann Individual Other Jan 1, 2022
Mississippi Baptist Health Systems, Inc Organization, Jackson, MS Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2011 100%
Brian Pickens Individual Corporate DirectorBoard Member Dec 10, 2020
Baptist Memorial Health Care Corporation Organization, Memphis, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest May 1, 2017 100%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Baptist Medical Center-Leake, Inc.Carthage, MS, CCN 25Z315 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2011
Baptist Medical Center-Leake, Inc.Carthage, MS, CCN 251315 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2011
BMC Leake Walnut Grove Primary CareWalnut Grove, MS, CCN 258536 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 1, 2011
BMC Leake Sebastopol Primary CareWalnut Grove, MS, CCN 258589 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)		 Nov 1, 2012
Nov 1, 2012

Owned or controlled facilities with NPI records 3

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

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651190400000",
    "number": "1194861260",
    "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": "601-267-1470",
            "fax_number": "601-267-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 HWY 16 EAST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390513809",
            "telephone_number": "601-267-1470",
            "fax_number": "601-267-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEDICAL CENTER-LEAKE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "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": "MS",
            "license": "11187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016232",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMC Leake Carthage Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carthage, MS

Sources for this page

Verify at the official NPI Registry.