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Organization Active NPI

Mississippi State Hospital Whitfield

  • Psychiatric Hospital
  • Whitfield, MS
National Provider Identifier
1467573543
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
31-139 Issued in MS
Legal business name
MISSISSIPPI STATE HOSPITAL WHITFIELD
Practice address
3550 Hwy 468 West
Whitfield, MS 39193-0157
Phone
(601) 351-8000
Fax
(601) 351-8586
NPI assigned
Apr 3, 2007
Last updated
May 2, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSISSIPPI STATE HOSPITAL WHITFIELDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2022

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

Authorized official

Name
Mr. James G Chastain
Title
Director
Phone
(601) 351-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 31-139 MS Primary

Addresses

Primary practice location

3550 Hwy 468 West
Whitfield, MS 39193-0157

Mailing address

P.O. Box 1 Fiscal Services
3550 Hwy 468 West
Whitfield, MS 39193-0157
Phone (601) 351-8000

Other identifiers 2

IdentifierTypeStateIssuer
00108537MedicaidMS
000020190OtherMSBLUE CROSS BLUE SHIELD

Other names 1

  • Mississippi State Hospital Room and Board Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050816000290 MS Part A Provider - Hospital 5294727533 Practice locations: Whitfield, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467573543. Details of each certification follow.

Hospital certification: CCN 254010

Legal name
MISSISSIPPI STATE HOSPITAL AT WHITFIELD
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jun 27, 2007
Last certification
Jun 27, 2007
Beds
306 (35 certified)
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Incorporated
Mar 4, 1935 in MS
Enrollment address
3550 Highway 468 W
Whitfield, MS 39193-5529
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ms State Hospital-WhitfieldCCN 254010 · All quality measures
Type
Psychiatric
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Ms State Hospital Crisis Intervention Center - Clevenlan21 organizations share this tax ID, including this one
Part of
Ms State Hospital Crisis Intervention Center - Clevenlan

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Carla Dearman Individual 5% Or Greater Direct Ownership Interest Jan 1, 2022
W-2 Managing EmployeeDirector of Revenue Jan 1, 2022
Amanda Matson Individual W-2 Managing EmployeeDirector of Revenue Jun 30, 2016
James Chastain Individual Corporate DirectorDirector Dec 1, 1993
Mary Tutor Individual W-2 Managing EmployeeBranch Director Jun 30, 2016

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.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1467573543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1 FISCAL SERVICES",
            "address_2": "3550 HWY 468 WEST",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000",
            "fax_number": "601-351-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 HWY 468 WEST",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000",
            "fax_number": "601-351-8586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI STATE HOSPITAL WHITFIELD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSISSIPPI STATE HOSPITAL WHITFIELD",
        "enumeration_date": "2007-04-03",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "CHASTAIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-351-8000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "MS",
            "license": "31-139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00108537",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000020190",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mississippi State Hospital Room and Board",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mississippi State Hospital Room and Board",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Whitfield, MS

Sources for this page

Verify at the official NPI Registry.