NPIMap

Organization Active NPI

Tyler Holmes Memorial Hospital

Doing business as Winona Fmaily Practice

  • Rural Health Clinic/Center
  • Winona, MS
National Provider Identifier
1285649855
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TYLER HOLMES MEMORIAL HOSPITAL
Doing business as
Winona Fmaily Practice
Practice address
700 Woodland Drive
Winona, MS 38967
Phone
(662) 283-3060
Fax
(662) 283-3553
NPI assigned
Jul 30, 2006
Last updated
Jan 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TYLER HOLMES MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Authorized official

Name
Memorie Lyons
Title
Clinic Director
Phone
(662) 283-6119

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

700 Woodland Drive
Winona, MS 38967

Mailing address

409 Tyler Holmes Drive
Winona, MS 38967
Phone (662) 283-4114

Other names 1

  • Winona Fmaily Practice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040126000826 MS Part B Supplier - Clinic/Group Practice 0345142618 Receives reassigned benefits from 14 practitioners
6 other NPIs on this enrollment
Practice locations: Winona, MS; North Carrollton, MS; Kilmichael, MS
O20190222000255 MS Part A Provider - Rural Health Clinic 0345142618 Practice locations: Winona, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285649855. Details of each certification follow.

Rural health clinic certification: CCN 258641

Legal name
TYLER HOLMES MEMORIAL HOSPITAL
Doing business as
WINONA FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 19, 2020
Last certification
Apr 28, 2026
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
700 Woodland Dr
Winona, MS 38967-1530
Related CCNs
251312

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Tyler Holmes Mem Hosp7 organizations share this tax ID, including this one
Part of
Tyler Holmes Mem Hosp

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Tyler Holmes Memorial Hospital Organization, Winona, MS Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2019
Cori Bailey Individual Corporate DirectorCfo Dec 1, 2008 100%
W-2 Managing EmployeeCfo Dec 1, 2008 100%
Steven K Rushing Individual Corporate DirectorMedical Director Oct 1, 2003 100%
W-2 Managing EmployeeMedical Director Oct 1, 2003 100%

Owners & managing parties with NPI records 4

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
Tyler Holmes Memorial HospitalWinona, MS, CCN 251312 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2003
Tyler Holmes Memorial Hospital Swing BedWinona, MS, CCN 25Z312 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2003
Crossroads Family MedicineWinona, MS, CCN 258640 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2019

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 3

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1285649855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 TYLER HOLMES DRIVE",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "38967",
            "telephone_number": "662-283-4114",
            "fax_number": "662-283-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WOODLAND DRIVE",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "38967",
            "telephone_number": "662-283-3060",
            "fax_number": "662-283-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER HOLMES MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TYLER HOLMES MEMORIAL HOSPITAL",
        "enumeration_date": "2006-07-30",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "MEMORIE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "662-283-6119"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winona Fmaily Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Winona Fmaily Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winona, MS

Sources for this page

Verify at the official NPI Registry.