NPIMap

Organization Active NPI

Southwest Mississippi Regional Medical Center

Doing business as Lawrence County Family Practice

  • Rural Health Clinic/Center
  • Monticello, MS
National Provider Identifier
1245289172
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Doing business as
Lawrence County Family Practice
Practice address
1167 E Broad St
Monticello, MS 39654-7682
Phone
(601) 587-1433
Fax
(601) 587-1625
NPI assigned
May 8, 2006
Last updated
Nov 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Authorized official

Name
Mrs. Charla Rowley
Title
Ceo
Phone
(601) 249-1806

Specialties & licenses 1

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

Addresses

Primary practice location

1167 E Broad St
Monticello, MS 39654-7682

Mailing address

PO Box 490
McComb, MS 39649-0490
Phone (601) 249-2701

Other practice location 1

700 Jefferson St S
Monticello, MS 39654-9580
Phone (601) 587-2593

Other identifiers 1

IdentifierTypeStateIssuer
06870336MedicaidMS

Other names 1

  • LAWRENCE COUNTY FAMILY PRACTICE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050629001212 MS Part A Provider - Rural Health Clinic 5193633907 1 other NPI on this enrollment
Practice locations: Monticello, MS
O20080512000004 MS Part B Supplier - Clinic/Group Practice 5193633907 Receives reassigned benefits from 86 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McComb, MS; Summit, MS; Monticello, MS
O20080512000089 MS Part B Supplier - Clinic/Group Practice 5193633907 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
Practice locations: Monticello, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245289172. Details of each certification follow.

Rural health clinic certification: CCN 258526

Legal name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Doing business as
LAWRENCE COUNTY FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 20, 2005
Last certification
Oct 18, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Enrollment address
1167 E Broad St
Monticello, MS 39654-7682
Related CCNs
251305

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

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 26

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

View all 26

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
25D1042295Lawrence County Family Practice1167 E Broad St, Monticello, MS 39654Certificate of waiverOct 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Smrmc Dba SW Internal M34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
City of McComb, Mississippi Organization, McComb, MS 5% Or Greater Direct Ownership Interest Oct 4, 1967 45%
Aaron P Price Individual Corporate DirectorChief Ambulatory Officer Jun 1, 2013
W-2 Managing EmployeeChief Ambulatory Officer Jun 1, 2013
Mallory Ginn Individual Corporate OfficerCfo Nov 28, 2012
Angela M Weems Individual W-2 Managing EmployeeCredentialing Officer Jun 1, 2013
Pike County Board of Supervisors Organization, Magnolia,, MS 5% Or Greater Direct Ownership Interest Oct 4, 1967 45%
Amite County, Board of Supervisors Organization, Liberty, MS 5% Or Greater Direct Ownership Interest Oct 4, 1967 10%
Charla Rowley Individual Corporate OfficerCeo Apr 17, 2014

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
St. Luke Home Health and HospiceMcComb, MS, CCN 257124 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2001
St. Luke Home Health and HospiceMonticello, MS, CCN 251687 Hospice 5% Or Greater Indirect Ownership Interest (100%) Feb 22, 2002
Southwest Primary CareMcComb, MS, CCN 258567 Rural health clinic 5% Or Greater Direct Ownership Interest Feb 1, 2012
Womens Health CenterMcComb, MS, CCN 258642 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2019
Nov 1, 2019
Lawrence County Board of SupervisorsMonticello, MS, CCN 258692 Rural health clinic Operational/Managerial Control Sep 27, 2001

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1245289172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396490490",
            "telephone_number": "601-249-2701",
            "fax_number": "601-249-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1167 E BROAD ST",
            "city": "MONTICELLO",
            "state": "MS",
            "postal_code": "396547682",
            "telephone_number": "601-587-1433",
            "fax_number": "601-587-1625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Jefferson St S",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "MS",
            "postal_code": "396549580",
            "country_code": "US",
            "telephone_number": "601-587-2593",
            "fax_number": "601-587-5352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "ROWLEY",
        "authorized_official_first_name": "CHARLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-249-1806",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06870336",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAWRENCE COUNTY FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LAWRENCE COUNTY FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, MS

Sources for this page

Verify at the official NPI Registry.