NPIMap

Organization Active NPI

Choctaw Regional Medical Center

Doing business as Choctaw Regional Medical Center Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Ackerman, MS
National Provider Identifier
1285041582
Registry record updated Jul 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
CHOCTAW REGIONAL MEDICAL CENTER
Doing business as
Choctaw Regional Medical Center Swingbed
Practice address
8613 Ms Highway 12
Ackerman, MS 39735-8917
Phone
(662) 285-4400
NPI assigned
Jul 18, 2014
Last updated
Jul 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2014

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

Authorized official

Name
Jamie Rodgers
Title
Administrator
Phone
(662) 285-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

8613 Ms Highway 12
Ackerman, MS 39735-8917

Mailing address

PO Box 719
Ackerman, MS 39735-0719
Phone (662) 285-4400

Other names 1

  • Choctaw Regional Medical Center Swingbed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141001002026 MS Part A Provider - Critical Access Hospital 2567682206 Practice locations: Ackerman, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285041582. Details of each certification follow.

Hospital certification: CCN 25Z334

Legal name
CHOCTAW REGIONAL MEDICAL CENTER
Organization structure
GovernmentNon-profit
Incorporated
Aug 1, 2014 in MS
Enrollment address
8613 Ms Highway 12
Ackerman, MS 39735-8917
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Choctaw Regional Medical Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Steve Marinelli Individual Corporate Officer Aug 1, 2020
Operational/Managerial Control Aug 1, 2020
Trella Long Individual W-2 Managing EmployeeMedical Records Manager Aug 1, 2014
Choctaw Regional Medical Center Organization, Ackerman, MS Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2014 100%
Susan Hollingsworth Individual Corporate DirectorClinic Administrator Jul 1, 2015
W-2 Managing EmployeeClinic Administrator & Insurance CR Aug 1, 2014 100%

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Choctaw Regional Medical CenterAckerman, MS, CCN 251334 Hospital Other Aug 1, 2014
Choctaw Medical ClinicAckerman, MS, CCN 258609 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2014
Louisville Medical ClinicLouisville, MS, CCN 258602 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2015
May 1, 2015

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406246400000",
    "number": "1285041582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "ACKERMAN",
            "state": "MS",
            "postal_code": "397350719",
            "telephone_number": "662-285-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8613 MS HIGHWAY 12",
            "city": "ACKERMAN",
            "state": "MS",
            "postal_code": "397358917",
            "telephone_number": "662-285-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOCTAW REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-07-25",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-285-4400"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Choctaw Regional Medical Center Swingbed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ackerman, MS

Sources for this page

Verify at the official NPI Registry.