NPIMap

Organization Active NPI

Covington County Hospital

Doing business as Family Care Magee

  • Rural Health Clinic/Center
  • Magee, MS
National Provider Identifier
1346822772
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COVINGTON COUNTY HOSPITAL
Doing business as
Family Care Magee
Practice address
360 Simpson Highway 149 Ste 170
Magee, MS 39111-3840
Phone
(601) 439-0635
NPI assigned
Apr 26, 2021
Last updated
Aug 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Authorized official

Name
Anissa L Evans
Title
Credentialing Director
Phone
(601) 698-0328

Specialties & licenses 1

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

Addresses

Primary practice location

360 Simpson Highway 149 Ste 170
Magee, MS 39111-3840

Mailing address

701 S Holly Ave
Collins, MS 39428-3894
Phone (601) 439-0635

Other names 1

  • Family Care Magee Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080722000557 MS Part B Supplier - Clinic/Group Practice 4183517253 Receives reassigned benefits from 33 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Collins, MS
O20210813000919 MS Part A Provider - Rural Health Clinic 4183517253 Practice locations: Magee, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346822772. Details of each certification follow.

Rural health clinic certification: CCN 258662

Legal name
COVINGTON COUNTY HOSPITAL
Doing business as
FAMILY CARE OF MAGEE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 22, 2021
Last certification
Sep 22, 2021
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
360 Simpson Hwy 149
Ste 170
Magee, MS 39111-3840
Related CCNs
251325

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
James McPhail Individual Corporate OfficerBoard Member Jan 15, 2009 25%
Corporate DirectorBoard Member Jan 15, 2009 25%
Covington County Hospital Organization, Collins, MS 5% Or Greater Direct Ownership Interest Jan 4, 2021 100%
Operational/Managerial Control Jan 4, 2021 100%
Robert Johnson Individual Corporate OfficerPresident Jan 23, 2007
Corporate DirectorPresident Jan 23, 2007
Greg Sullivan Individual Corporate OfficerBoard Member Jan 15, 2008 25%
Corporate DirectorBoard Member Jan 15, 2008 25%
Gregg Gibbes Individual Corporate OfficerCheif Executive Officer Oct 14, 2014
Operational/Managerial ControlCeo Oct 14, 2014
Everlean Booth Individual Corporate OfficerSecretary Nov 18, 2005 25%
Corporate DirectorSecretary Nov 18, 2005 25%

Owners & managing parties with NPI records 15

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

  • Covington County Hospital

    dba Smith County EH Pro Fees

    • Emergency Medical Services (Emergency Medicine) Physician
    • Raleigh, MS
    • NPI 1003654567

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Family Care Express

    • Rural Health Clinic/Center
    • Collins, MS
    • NPI 1013205350

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Smith County Emergency Hospital

    • Rural Acute Care Hospital
    • Raleigh, MS
    • NPI 1043051543

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Arrington Living Center

    • Skilled Nursing Facility
    • Collins, MS
    • NPI 1053615518

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba CCH Clinic Seminary

    • Rural Health Clinic/Center
    • Seminary, MS
    • NPI 1134435498

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital
    • Critical Access Hospital
    • Collins, MS
    • NPI 1215965249

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital
    • Psychiatric Hospital Unit
    • Collins, MS
    • NPI 1225150436

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Family Care Magee Tuscan Towers

    • Rural Health Clinic/Center
    • Magee, MS
    • NPI 1225704208

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba CCH Clinic Taylorsville

    • Rural Health Clinic/Center
    • Taylorsville, MS
    • NPI 1306460282

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Green Tree Family Medical Clinic

    • Rural Health Clinic/Center
    • Mount Olive, MS
    • NPI 1336447861

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Family Care of Main Street

    • Rural Health Clinic/Center
    • Collins, MS
    • NPI 1518260330

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba CCH Clinic Family Medical

    • Rural Health Clinic/Center
    • Collins, MS
    • NPI 1598769044

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
View all 15

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Covington County HospitalCollins, MS, CCN 25M325 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2016
Arrington Living CenterCollins, MS, CCN 255331 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2011
May 1, 2011
Family Medical AssociatesCollins, MS, CCN 253497 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2016
Family Care ExpressCollins, MS, CCN 258562 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2016
Jan 1, 2016
CCH Clinic MageeMagee, MS, CCN 258597 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 2018
Mar 1, 2018
Express Care SumrallSumrall, MS, CCN 258644 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Family Care Magee Tuscan TowersMagee, MS, CCN 258660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 1, 2021
Sep 1, 2021

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 7

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

NPI Registry JSON

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1346822772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 S HOLLY AVE",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394283894",
            "telephone_number": "601-439-0635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SIMPSON HIGHWAY 149 STE 170",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113840",
            "telephone_number": "601-439-0635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ANISSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "601-698-0328"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Magee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Magee, MS

Sources for this page

Verify at the official NPI Registry.