NPIMap

Organization Active NPI

Forrest County General Hospital

Doing business as The Doctors Clinic

  • Rural Health Clinic/Center
  • Richton, MS
National Provider Identifier
1205974201
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FORREST COUNTY GENERAL HOSPITAL
Practice address
210 Bay Ave
Richton, MS 39476-1237
Phone
(601) 788-9222
Fax
(601) 788-6635
NPI assigned
Feb 2, 2007
Last updated
May 16, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
FORREST COUNTY GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2022

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

Authorized official

Name
Ben Hester
Title
Cfo
Phone
(601) 288-4225

Specialties & licenses 1

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

Addresses

Primary practice location

210 Bay Ave
Richton, MS 39476-1237

Mailing address

PO Box 1728
Jackson, MS 39215-1728
Phone (601) 288-4338

Other names 1

  • The Doctors Clinic Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220228001008 MS Part A Provider - Rural Health Clinic 1052397767 Practice locations: Richton, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205974201. Details of each certification follow.

Rural health clinic certification: CCN 253452

Legal name
FORREST COUNTY GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 2, 1995
Last certification
Oct 28, 2019
Ownership / control type
1C
Most recent change of ownership
Jan 1, 2003 (4 total)
Organization structure
GovernmentNon-profit
Enrollment address
210 Bay Ave
Richton, MS 39476-9665
Related CCNs
251306

Other NPIs with the same Medicare PAC ID 24

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

View all 24

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
25D0894164Doctors Clinic, the210 Bay Avenue, Richton, MS 39476Certificate of waiverNov 7, 2026

National Provider Directory

National Provider Directory
Tax ID family
Forrest General Cancer Center41 organizations share this tax ID, including this one
Part of
Forrest General Cancer Center

Other organizations with this tax ID 40

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

View all 40

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Erik Steele Individual Corporate OfficerSec. of Board of Trustees Jan 1, 2022
Corporate DirectorMember of Board of Trustees Jan 1, 2022
Operational/Managerial ControlMember of Board of Trustees Jan 1, 2022
Forrest County General Hospital Organization, Hattiesburg, MS Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
James Lynn Cartlidge Individual Corporate DirectorMember of Board of Trustees Jan 1, 2022
Operational/Managerial ControlMember of the Board of Trustees Jan 1, 2022
Sheree Jenkins Individual W-2 Managing EmployeeDirector of Revenue Systems Jan 1, 2022
Operational/Managerial ControlDirector of Revenue Systems Jan 1, 2022
Richard Andy Woodard Individual Corporate OfficerChief Executive Officer Jan 1, 2022
W-2 Managing EmployeeChief Executive Officer Jan 1, 2022
Operational/Managerial ControlChief Executive Officer Jan 1, 2022
John M Keene Individual Corporate OfficerVice Chairman. Board of Trustees Jan 1, 2022
Corporate DirectorMember of Board of Trustees Jan 1, 2022
Operational/Managerial ControlMember of Board of Trustees Jan 1, 2022
Ben R Hester Individual Corporate OfficerVP/ Chief Financial Officer Jan 1, 2022
W-2 Managing EmployeeVP. Chief Financial Officer Jan 1, 2022
Operational/Managerial ControlVP/ Chief Financial Officer Jan 1, 2022
Melissa a Watson Individual W-2 Managing Employee Jan 1, 2022
Courtney Lowrimore Individual W-2 Managing EmployeePayer Credentialing Specialist Jan 1, 2022
Bryan K Maxie Individual W-2 Managing EmployeeRegional Administrator Jan 1, 2022
Operational/Managerial ControlRegional Administrator Jan 1, 2022
Marcus L Hogan Individual Corporate DirectorMember of Board of Trustees Jan 1, 2022
Operational/Managerial ControlMember of the Board of Trustees Jan 1, 2022
Richard W Preusch Individual Corporate OfficerChairman of the Board of Trustee Jan 1, 2022
Corporate DirectorMember of Board of Trustees Jan 1, 2022
Operational/Managerial ControlMember of Board of Trustees Jan 1, 2022

Owners & managing parties with NPI records 24

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

View all 24

All facility ownership & control disclosures 16

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

FacilityTypeRoleSince
Highland Community HospitalPicayune, MS, CCN 250117 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 May 1, 2006
May 1, 2006
The Orthopedic InstituteHattiesburg, MS, CCN 250078 Hospital 5% Or Greater Direct Ownership Interest Jul 15, 1952
Marion General HospitalColumbia, MS, CCN 250085 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2012
Marion General HospitalColumbia, MS, CCN 25U085 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2012
Jefferson Davis Community Hospital Swing BedPrentiss, MS, CCN 25Z326 Hospital Operational/Managerial Control (100%) Jul 1, 2011
Pearl River County Hospital and Nursing HomePoplarville, MS, CCN 251333 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2020
Feb 1, 2020
Pearl River County Hospital Swing BedPoplarville, MS, CCN 25Z333 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2020
Feb 1, 2020
Jefferson Davis Extended Care FacilityPrentiss, MS, CCN 255050 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2012
Pearl River County Hospital and Nursing HomePoplarville, MS, CCN 255349 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2020
Feb 1, 2020
Forrest General Home Care of Marion GeneralColumbia, MS, CCN 257089 Home health agency 5% Or Greater Direct Ownership Interest Jan 1, 2012
Jefferson Davis Rural Health ClinicPrentiss, MS, CCN 258523 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2011
Jul 1, 2011
Marion County General HospitalColumbia, MS, CCN 258612 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2014
Oct 1, 2007
Highland Pediatric and Primary Care Rural Health ClinicPicayune, MS, CCN 258631 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 1, 2018
Dec 1, 2018
Forrest County General HospitalPoplarville, MS, CCN 258556 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2020
Feb 1, 2020
Highland Center for Women's HealthPicayune, MS, CCN 258683 Rural health clinic Operational/Managerial Control Aug 13, 2017
Highland Family Medicine ClinicPicayune, MS, CCN 258673 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jun 1, 2022
Jun 1, 2022

Owned or controlled facilities with NPI records 16

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

View all 16

Facilities with the same owner 16

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

View all 16

Change-of-ownership history 2

DateEventCounterparty
Jan 1, 2022 Change of OwnershipThis provider was the buyer The Doctors ClinicCCN 253452, MS, NPI 1205974201
Jan 1, 2022 Change of OwnershipThis provider was the seller Forrest County General HospitalCCN 253452, MS, NPI 1205974201

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652659200000",
    "number": "1205974201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1728",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392151728",
            "telephone_number": "601-288-4338",
            "fax_number": "601-288-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 BAY AVE",
            "city": "RICHTON",
            "state": "MS",
            "postal_code": "394761237",
            "telephone_number": "601-788-9222",
            "fax_number": "601-788-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORREST COUNTY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORREST COUNTY GENERAL HOSPITAL",
        "enumeration_date": "2007-02-02",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A",
        "authorized_official_last_name": "HESTER",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-288-4225"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Doctors Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Doctors Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Richton, MS

Sources for this page

Verify at the official NPI Registry.