Forrest County General Hospital
Organization Active NPI Rural Health Clinic/Center · Richton, MS
NPI 1205974201 · NPPES record last updated May 16, 2022
Key facts
- NPI
- 1205974201
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- Yes
- Parent organization (as reported)
- FORREST COUNTY GENERAL HOSPITAL
Authorized official
- Name
- Ben Hester
- Title
- Cfo
- Phone
- (601) 288-4225
Owners & managing parties with NPI records 24
Owned or controlled facilities with NPI records 16
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 40
Facilities with the same owner 16
Practitioners 110
-
Charles R. Griffith, M.D.
-
L. Wesley Aldred, M.D.
-
George M Anderson, M.D.
-
Joseph Anderson, PMHNP-BC
-
Roopsi Bassi, MD
-
Berthold Beisel, MD
-
Siddeeqah Bilal, M.D.
-
Santo M Borganelli, MD FACC
-
Stephanie Kay Bounds, PMHNP-BC
-
Robert B Brahan, MD
-
Karen H Bruce, M.D.
-
Jefferson Buntin, N.P.
-
Heather Conn, FNP, PMHNP-BC
-
Courtney Lynn Cruthirds, PMHNP
-
Justin Defee, LPC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0894164 | Doctors Clinic, the | Certificate of waiver | Nov 7, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
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
- Government · Non-profit
- Enrollment address
- 210 Bay Ave
Richton, MS 39476-9665 - Related CCNs
- 251306
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Erik Steele |
Corporate Officer |
Jan 1, 2022 | |
| Corporate Director |
Jan 1, 2022 | ||
| Operational/Managerial Control |
Jan 1, 2022 | ||
| Forrest County General Hospital |
5% Or Greater Direct Ownership Interest | Jan 1, 2022 | 100% |
| James Lynn Cartlidge |
Corporate Director |
Jan 1, 2022 | |
| Operational/Managerial Control |
Jan 1, 2022 | ||
| Sheree Jenkins |
W-2 Managing Employee |
Jan 1, 2022 | |
| Operational/Managerial Control |
Jan 1, 2022 | ||
| Richard Andy Woodard |
Corporate Officer |
Jan 1, 2022 | |
| W-2 Managing Employee |
Jan 1, 2022 | ||
| Operational/Managerial Control |
Jan 1, 2022 | ||
| John M Keene |
Corporate Officer |
Jan 1, 2022 | |
| Corporate Director |
Jan 1, 2022 | ||
| Operational/Managerial Control |
Jan 1, 2022 | ||
| Ben R Hester |
Corporate Officer |
Jan 1, 2022 | |
| W-2 Managing Employee |
Jan 1, 2022 | ||
| Operational/Managerial Control |
Jan 1, 2022 | ||
| Melissa a Watson |
W-2 Managing Employee | Jan 1, 2022 | |
| Courtney Lowrimore |
W-2 Managing Employee |
Jan 1, 2022 | |
| Bryan K Maxie |
W-2 Managing Employee |
Jan 1, 2022 | |
| Operational/Managerial Control |
Jan 1, 2022 | ||
| Marcus L Hogan |
Corporate Director |
Jan 1, 2022 | |
| Operational/Managerial Control |
Jan 1, 2022 | ||
| Richard W Preusch |
Corporate Officer |
Jan 1, 2022 | |
| Corporate Director |
Jan 1, 2022 | ||
| Operational/Managerial Control |
Jan 1, 2022 |
All facility ownership & control disclosures 16
| Facility | Type | Role | Since |
|---|---|---|---|
| Highland Community Hospital |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
May 1, 2006 May 1, 2006 |
| The Orthopedic Institute |
Hospital | 5% Or Greater Direct Ownership Interest | Jul 15, 1952 |
| Marion General Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2012 |
| Marion General Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2012 |
| Jefferson Davis Community Hospital Swing Bed |
Hospital | Operational/Managerial Control (100%) | Jul 1, 2011 |
| Pearl River County Hospital and Nursing Home |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Feb 1, 2020 Feb 1, 2020 |
| Pearl River County Hospital Swing Bed |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Feb 1, 2020 Feb 1, 2020 |
| Jefferson Davis Extended Care Facility |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2012 |
| Pearl River County Hospital and Nursing Home |
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 General |
Home health agency | 5% Or Greater Direct Ownership Interest | Jan 1, 2012 |
| Jefferson Davis Rural Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jul 1, 2011 Jul 1, 2011 |
| Marion County General Hospital |
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 Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Dec 1, 2018 Dec 1, 2018 |
| Forrest County General Hospital |
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 Health |
Rural health clinic | Operational/Managerial Control | Aug 13, 2017 |
| Highland Family Medicine Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jun 1, 2022 Jun 1, 2022 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jan 1, 2022 | Change of Ownership |
The Doctors Clinic |
| Jan 1, 2022 | Change of Ownership |
Forrest County General Hospital |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220228001008 | MS | Part a Provider - Rural Health Clinic | 1052397767 | Practice locations: Richton, MS |
National Provider Directory
- Tax ID family
- Forrest County Gen Hospital
- Part of
- Forrest County Gen Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09014921 | Medicaid | MS |
Other names
- The Doctors Clinic
Other providers in Richton, MS
- Dr Michael S Zaleski
- Lashunda Everett
- Express Care Medical Clinic LLC
- Family Care Clinic
- Crystal Ferrell
- Forrest County General Hospital
- Forrest County General Hospital
- Forrest County General Hospital
- Esmerelda Gordillo
- Crystal Dale Grantham
All providers in Richton, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.