NPIMap

Organization Active NPI

State of Mississippi - University of Mississippi Medical Center

Doing business as UMMC Greenwood Primary Care Clinic

  • Rural Health Clinic/Center
  • Greenwood, MS
National Provider Identifier
1336911536
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Doing business as
UMMC Greenwood Primary Care Clinic
Practice address
408 W Market St
Greenwood, MS 38930-4253
Phone
(662) 227-7000
NPI assigned
Oct 23, 2023
Last updated
Oct 23, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Authorized official

Name
Mr. Scott Whittemore
Title
Cfo
Phone
(662) 227-7172

Specialties & licenses 1

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

Addresses

Primary practice location

408 W Market St
Greenwood, MS 38930-4253

Mailing address

960 Avent Dr
Grenada, MS 38901-5230
Phone (662) 227-7172

Other names 1

  • UMMC Greenwood Primary Care Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231116003221 MS Part A Provider - Rural Health Clinic 1850293036 Practice locations: Greenwood, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336911536. Details of each certification follow.

Rural health clinic certification: CCN 258679

Legal name
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Doing business as
UMMC GREENWOOD PRIMARY CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 5, 2024
Last certification
Sep 5, 2024
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
408 W Market St
Greenwood, MS 38930-4253
Related CCNs
250168

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

Other NPIs with the same Medicare PAC ID 22

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

View all 22

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
25D0896743Ummc - Greenwood Primary Care Clinic408 W Market Dr, Greenwood, MS 38930ComplianceAug 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
State of Ms Univ of Ms Med62 organizations share this tax ID, including this one
Part of
State of Ms Univ of Ms Med

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
State of Mississippi-University of Mississippi Medical Center Organization, Grenada, MS Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2023
Scott Whittemore Individual Corporate Officer Oct 1, 2023
W-2 Managing Employee Oct 1, 2023

Owners & managing parties with NPI records 22

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

View all 22

All facility ownership & control disclosures 14

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

FacilityTypeRoleSince
State of Mississippi-University of Mississippi Medical CenterJackson, MS, CCN 250001 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2007
Jul 1, 2007
University of Mississi Medical Center- Holmes CountyLexington, MS, CCN 25Z319 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2004
Holmes County Hospital & ClinicsLexington, MS, CCN 251319 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2004
Ummc- GrenadaGrenada, MS, CCN 250168 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 21, 2014
Feb 21, 2014
Ummc MadisonCanton, MS, CCN 250038 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Ummc MadisonCanton, MS, CCN 25U038 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Lexington Rural Health ClinicLexington, MS, CCN 253813 Rural health clinic 5% Or Greater Direct Ownership Interest May 23, 2013
West Rural Health ClinicWest, MS, CCN 253812 Rural health clinic 5% Or Greater Direct Ownership Interest May 22, 2013
Ummc- Grenada Women's ServicesGrenada, MS, CCN 258626 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Holmes County Family Medicine Clinic- VaidenVaiden, MS, CCN 258625 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2016
Ummc Grenada Specialty PediatricsGrenada, MS, CCN 258627 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Children's of Mississippi Greenwood ClinicGreenwood, MS, CCN 258682 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Women's ClinicGreenwood, MS, CCN 258680 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Grenada Primary Medicine ClinicGrenada, MS, CCN 258681 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023

Owned or controlled facilities with NPI records 15

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

View all 15

Facilities with the same owner 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1336911536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 AVENT DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389015230",
            "telephone_number": "662-227-7172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 W MARKET ST",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389304253",
            "telephone_number": "662-227-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
        "enumeration_date": "2023-10-23",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "WHITTEMORE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "662-227-7172",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UMMC Greenwood Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenwood, MS

Sources for this page

Verify at the official NPI Registry.