NPIMap

Organization Active NPI

South Central Clinics, Inc.

Doing business as Ellisville Pediatric Clinic

  • Rural Health Clinic/Center
  • Ellisville, MS
National Provider Identifier
1427098003
Registry record updated Mar 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
253437 Issued in MS
Legal business name
SOUTH CENTRAL CLINICS, INC.
Doing business as
Ellisville Pediatric Clinic
Practice address
1203 Ave B
Suite 200
Ellisville, MS 39437
Phone
(601) 477-3550
Fax
(601) 477-2236
NPI assigned
Jun 8, 2006
Last updated
Mar 13, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH CENTRAL REGIONAL MED CTRAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2026

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

Authorized official

Name
Chancie Kreger
Title
Director
Phone
(601) 399-6152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 253437 MS Primary

Addresses

Primary practice location

1203 Ave B
Suite 200
Ellisville, MS 39437

Mailing address

PO Box 247
Laurel, MS 39441-0247
Phone (601) 425-7550

Other practice location 1

1220 Jefferson St
Laurel, MS 39440-4355
Phone (601) 426-4000

Other identifiers 1

IdentifierTypeStateIssuer
09014135MedicaidMS

Other names 1

  • Ellisville Pediatric Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180126000848 MS Part A Provider - Rural Health Clinic 4385876655 Practice locations: Ellisville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427098003. Details of each certification follow.

Rural health clinic certification: CCN 253437

Legal name
SOUTH CENTRAL CLINICS, INC
Doing business as
ELLISVILLE PEDIATRIC CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 17, 1995
Last certification
Aug 13, 2018
Ownership / control type
2B
Organization structure
OtherProprietary
Incorporated
Dec 14, 2012 in MS
Enrollment address
1203 Ave B
Ellisville, MS 39437-2080
Related CCNs
250058

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
South Central Cinics Inc23 organizations share this tax ID, including this one
Part of
South Central Regional Medical Ctr

Other organizations with this tax ID 22

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

View all 22

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Elsa Brewer Individual Corporate OfficerBoard Member Dec 14, 2012
Victor Jones Individual Corporate OfficerBoard Member Dec 14, 2012
Lewis Goins Individual Corporate OfficerBoard Member Dec 14, 2012
Chancie Kreger Individual W-2 Managing Employee Jan 1, 2023
Arthur Siggers Individual Corporate OfficerBoard Member Dec 14, 2012
Michael Lowe Individual Corporate OfficerBoard Member Dec 14, 2012
South Central Regional Medical Center Organization, Laurel, MS 5% Or Greater Direct Ownership Interest Dec 14, 2012 100%
Gregg Gibbes Individual Contracted Managing EmployeePresident and Ceo Jul 1, 2023
5% Or Greater Direct Ownership InterestPresident and Ceo Jul 1, 2023 5%
James Canizaro Individual Corporate OfficerVP of Finance/Cfo Dec 14, 2012
W-2 Managing EmployeeCfo/VP of Finance Dec 14, 2012
George Walters Individual Corporate OfficerBoard Member Dec 14, 2012

Owners & managing parties with NPI records 9

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

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 77

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 77

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773360000000",
    "number": "1427098003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247",
            "telephone_number": "601-425-7550",
            "fax_number": "601-399-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 AVE B",
            "address_2": "SUITE 200",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "39437",
            "telephone_number": "601-477-3550",
            "fax_number": "601-477-2236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1220 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MS",
            "postal_code": "394404355",
            "country_code": "US",
            "telephone_number": "601-426-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH CENTRAL CLINICS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH CENTRAL REGIONAL MED CTR",
        "enumeration_date": "2006-06-08",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "status": "A",
        "authorized_official_last_name": "KREGER",
        "authorized_official_first_name": "CHANCIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-399-6152"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "253437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014135",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellisville Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellisville Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellisville, MS

Sources for this page

Verify at the official NPI Registry.