NPIMap

Organization Active NPI

Covington County Hospital

  • Critical Access Hospital
  • Collins, MS
National Provider Identifier
1215965249
Registry record updated Nov 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
11-181 Issued in MS
Legal business name
COVINGTON COUNTY HOSPITAL
Practice address
701 S Holly Ave
Collins, MS 39428-3894
Phone
(601) 765-6711
Fax
(601) 698-0180
NPI assigned
Jun 29, 2006
Last updated
Nov 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2008

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

Authorized official

Name
Mr. Jamie Rodgers
Title
Administrator
Phone
(601) 765-6711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 11-181 MS Primary

Addresses

Primary practice location

701 S Holly Ave
Collins, MS 39428-3894

Mailing address

701 S Holly Ave
Collins, MS 39428-3894
Phone (601) 765-6711

Other identifiers 2

IdentifierTypeStateIssuer
00020133MedicaidMS
000019133OtherMSBC/BS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080912000358 MS Part A Provider - Critical Access Hospital 4183517253 Receives reassigned benefits from 1 practitioner
Practice locations: Collins, MS
O20080912000389 MS Part A Provider - Critical Access Hospital 4183517253 Practice locations: Collins, MS

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1215965249. Details of each certification follow.

Hospital certification: CCN 251325

Legal name
COVINGTON COUNTY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2006
Last certification
Mar 20, 2013
Beds
35
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1951 in MS
Enrollment address
701 S Holly Ave
Collins, MS 39428-3894
Main/Primary Hospital Location

Hospital certification: CCN 25Z325

Legal name
COVINGTON COUNTY HOSPITAL
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1951 in MS
Enrollment address
701 S Holly Ave
Collins, MS 39428-3894

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Care Compare: Hospital

Medicare Care Compare
Listed as
Covington County Hospital CahCCN 251325 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Covington County Hospital15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Greg Sanford Individual Corporate DirectorBoard Member Jan 15, 2008 100%
James McPhail Individual Corporate DirectorBoard Member Jan 15, 2009 100%
Charlie Anglin Individual Corporate DirectorBoard Member Oct 8, 2007 100%
Robert Johnson Individual Corporate DirectorBoard Member Jan 23, 2007 100%
Greg Sullivan Individual Corporate DirectorBoard Member Oct 8, 2007 100%
Missy L Gamber Individual Contracted Managing EmployeeDirector of Credentialing Jan 1, 2016
Gregg Gibbes Individual Corporate OfficerCeo Apr 28, 2016 100%
W-2 Managing EmployeeCeo Apr 28, 2016 100%
Operational/Managerial ControlCeo Apr 28, 2016 100%
Everlean Booth Individual Corporate DirectorBoard Member Nov 18, 2005 100%

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Covington County HospitalCollins, MS, CCN 25M325 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2016
Arrington Living CenterCollins, MS, CCN 255331 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2011
May 1, 2011
Family Medical AssociatesCollins, MS, CCN 253497 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2016
Family Care ExpressCollins, MS, CCN 258562 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2016
Jan 1, 2016
CCH Clinic MageeMagee, MS, CCN 258597 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 2018
Mar 1, 2018
Express Care SumrallSumrall, MS, CCN 258644 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Family Care of MageeMagee, MS, CCN 258662 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 4, 2021
Jan 4, 2021
Family Care Magee Tuscan TowersMagee, MS, CCN 258660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 1, 2021
Sep 1, 2021

Owned or controlled facilities with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 83

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

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226534400000",
    "number": "1215965249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 S HOLLY AVE",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394283894",
            "telephone_number": "601-765-6711",
            "fax_number": "601-698-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S HOLLY AVE",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394283894",
            "telephone_number": "601-765-6711",
            "fax_number": "601-698-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2008-11-13",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-765-6711",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "11-181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020133",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000019133",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Collins, MS

Sources for this page

Verify at the official NPI Registry.