NPIMap

Choctaw Regional Medical Center

Organization Active NPI Family Medicine Physician · Ackerman, MS

NPI 1235547878 · NPPES record last updated May 28, 2025

Key facts

NPI
1235547878
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
CHOCTAW REGIONAL MEDICAL CENTER
Practice address
64 N Louisville St
Ackerman, MS 39735-9217
Phone
(662) 285-9050
NPI assigned
Jul 28, 2014
Organization subpart
No

Authorized official

Name
Susan Hollingsworth
Title
Administrator & Credentialing
Phone
(662) 285-9460

Owned or controlled facilities with NPI records 4

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

Other NPIs on the same Medicare enrollment 3

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

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 7

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

Practitioners 67

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

View all 67

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2017094Choctaw Medical Clinic of Ackerman
64 North Louisville Street, Ackerman, MS 39735		Certificate of waiverDec 2, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Choctaw Regional Medical Center
Ackerman, MS · CCN 251334		 Hospital Other Aug 1, 2014
Choctaw Regional Medical Center
Ackerman, MS · CCN 25Z334		 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2014
Choctaw Medical Clinic
Ackerman, MS · CCN 258609		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2014
Louisville Medical Clinic
Louisville, MS · CCN 258602		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2015
May 1, 2015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20141215002502 MS Part B Supplier - Clinic/Group Practice 2567682206 Receives reassigned benefits from 67 practitioners
3 other NPIs on this enrollment
Practice locations: Ackerman, MS; Louisville, MS

National Provider Directory

Tax ID family
Choctaw Regional Medical Center (8 organizations share this tax ID)

Locations

14724 Highway 15 N
Louisville, MS 39339
Phone (662) 773-7500

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

64 N Louisville St
Ackerman, MS 39735-9217

Mailing address

8613 Ms Highway 12
Ackerman, MS 39735-8917
Phone (662) 285-9460

Other names

  • Choctaw Medical Clinic of Ackerman Doing business as

Other providers in Ackerman, MS

All providers in Ackerman, MS · Family Medicine Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.