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State of Mississippi - University of Mississippi Medical Center

Organization Active NPI Critical Access Hospital · Lexington, MS

NPI 1386630705 · NPPES record last updated Dec 12, 2018

Key facts

NPI
1386630705
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Practice address
239 Bowling Green Rd
Lexington, MS 39095-5167
Phone
(662) 834-1321
Fax
(601) 815-6301
NPI assigned
Sep 21, 2005
Organization subpart
No

Authorized official

Name
Mr. Jeffrey Grimsley
Title
Cfo
Phone
(601) 815-6270

Owners & managing parties with NPI records 22

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

Owned or controlled facilities with NPI records 15

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

Other NPIs on the same Medicare enrollment 15

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

Other NPIs with the same Medicare PAC ID 22

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

Corporate family (same tax ID) 24

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

Member organizations 10

Organizations listed as members of this organization in the National Provider Directory.

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

Facilities with the same owner 14

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

Practitioners 1,284

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 1,284

Affiliated clinicians 42

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

View all 42

Medicare Care Compare: Hospital

Listed as
Holmes County Hospital and Clinics CCN 251319
Type
Critical Access Hospitals
Ownership
Government - State
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Hospital certification: CCN 251319

Legal name
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Doing business as
HOLMES COUNTY HOSPITAL & CLINICS
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2004
Last certification
Mar 25, 2014
Beds
25
Ownership / control type
State
Organization structure
Government · Proprietary
Enrollment address
239 Bowling Green Road
Holmes County Hospital & Clinics
Lexington, MS 39095-5167
Other Hospital Practice Location

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
Jeffrey G Grimsley
Individual 		Corporate Officer
Health System Cfo		 Sep 1, 2014
W-2 Managing Employee
Health System Cfo		 Sep 1, 2014
State of Mississippi-University of Mississippi Medical Center
Organization · Jackson, MS 		5% Or Greater Direct Ownership Interest Oct 1, 2004

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 Center
Jackson, 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 County
Lexington, MS · CCN 25Z319		 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2004
Ummc- Grenada
Grenada, MS · CCN 250168		 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 21, 2014
Feb 21, 2014
Ummc Madison
Canton, MS · CCN 250038		 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Ummc Madison
Canton, MS · CCN 25U038		 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Lexington Rural Health Clinic
Lexington, MS · CCN 253813		 Rural health clinic 5% Or Greater Direct Ownership Interest May 23, 2013
West Rural Health Clinic
West, MS · CCN 253812		 Rural health clinic 5% Or Greater Direct Ownership Interest May 22, 2013
Ummc- Grenada Women'S Services
Grenada, MS · CCN 258626		 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Holmes County Family Medicine Clinic- Vaiden
Vaiden, MS · CCN 258625		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2016
Ummc Grenada Specialty Pediatrics
Grenada, MS · CCN 258627		 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Children'S of Mississippi Greenwood Clinic
Greenwood, MS · CCN 258682		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Primary Care Clinic
Greenwood, MS · CCN 258679		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Women'S Clinic
Greenwood, MS · CCN 258680		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Grenada Primary Medicine Clinic
Grenada, MS · CCN 258681		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080702000327 MS Part a Provider - Critical Access Hospital 1850293036 Practice locations: Lexington, MS
O20090414000575 MS Part B Supplier - Clinic/Group Practice 1850293036 Receives reassigned benefits from 1,922 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Sigurds O Krolls MD (62 organizations share this tax ID)

Locations (25 of 90)

8400 Holcomb Bridge Rd
Ste 440
Alpharetta, GA 30022
Phone (770) 645-1222

5777 Old Winder Hwy
Braselton, GA 30517
Phone (770) 534-5305

4153 Lawrenceville Hwy NW
Ste 5
Lilburn, GA 30047
Phone (770) 921-4707

1675 Cumberland Pkwy SE
Ste 103
Smyrna, GA 30080
Phone (770) 438-0202

2053 Gause Blvd E
Ste 200
Slidell, LA 70461
Phone (985) 259-8045

2055 Gause Blvd E
Ste 300
Slidell, LA 70461
Phone (985) 649-0023

970 Tommy Munro Dr
Ste B
Biloxi, MS 39532
Phone (228) 388-4585

203 W Peace St
Canton, MS 39046
Phone (601) 407-6104

185 Medical Pkwy
Ste 202
Flowood, MS 39232

415 S 28th Ave
Ste 1
Hattiesburg, MS 39401

415 S 28th Ave
Ste 2B
Hattiesburg, MS 39401

415 S 28th Ave
#4B
Hattiesburg, MS 39401
Phone (601) 579-5430

415 S 28th Ave
Ste 6C
Hattiesburg, MS 39401

415 S 28th Ave
#4A
Hattiesburg, MS 39401

6414 U S Highway 98
Hattiesburg, MS 39402
Phone (601) 296-2833

3688 Veterans Memorial Dr
Hattiesburg, MS 39401
Phone (601) 271-8953

6614 U S Highway 98
Hattiesburg, MS 39402

102 Medical Park
Ste B
Hattiesburg, MS 39401
Phone (601) 261-1650

421 S 28th Ave
Ste 310
Hattiesburg, MS 39401
Phone (601) 579-5261

415 S 28th Ave
#2A
Hattiesburg, MS 39401

415 S 28th Ave
Ste 4B
Hattiesburg, MS 39401

6141 U S Hwy 98 Ste 120
Hattiesburg, MS 39402

103 Asbury Cir
Hattiesburg, MS 39402
Phone (601) 268-5150

103 Medical Park
Fl 1
Hattiesburg, MS 39401
Phone (601) 268-5630

415 S 28th Ave
Ste 2A
Hattiesburg, MS 39401

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Yes

Addresses

Primary practice location

239 Bowling Green Rd
Lexington, MS 39095-5167

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (662) 834-1321

Other identifiers

IdentifierTypeStateIssuer
000020838OtherMSBLUE CROSS
000020838OtherMSSTATE OF MS
00220609MedicaidMS
C02544OtherMSMEDICARE

Other names

  • Holmes County Hospital and Clinic Doing business as

Other providers in Lexington, MS

All providers in Lexington, MS · Critical Access Hospital in Mississippi

Sources for this page

Verify at the official NPI Registry.