NPIMap

Organization Active NPI

Winston County Medical Foundation

  • Medicare Defined Swing Bed Hospital Unit
  • Louisville, MS
National Provider Identifier
1518098367
Registry record updated Oct 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
WINSTON COUNTY MEDICAL FOUNDATION
Practice address
562 E Main St
Louisville, MS 39339-2742
Phone
(662) 779-5101
Fax
(662) 773-6223
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2011

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

Authorized official

Name
Gary Lee McCall Jr.
Title
Ceo
Phone
(662) 779-5102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

562 E Main St
Louisville, MS 39339-2742

Mailing address

PO Box 967
Louisville, MS 39339-0967
Phone (662) 773-6211

Other identifiers 1

IdentifierTypeStateIssuer
00220250MedicaidMS

Other names 1

  • Winston Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100520000573 MS Part A Provider - Hospital 7315943255 Practice locations: Louisville, MS

Hospital certification: CCN 25U027

Legal name
WINSTON COUNTY MEDICAL FOUNDATION
Doing business as
WINSTON MEDICAL CENTER
Organization structure
OtherNon-profit
Incorporated
Sep 23, 1993 in MS
Enrollment address
17550 E Main St
Louisville, MS 39339-2772
Other Hospital Practice Location
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Winston County Medical Foundation9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
James Woodward Individual Corporate DirectorController Aug 25, 2015
Paul S. Black Individual Corporate Officer Jul 5, 2011
Corporate Director Jul 5, 2011
Operational/Managerial Control Jul 5, 2011
Winston County Medical Foundation Organization, Louisville, MS Created for acquisition, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 1994 100%
Operational/Managerial Control Jul 5, 1994

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Winston Medical CenterLouisville, MS, CCN 25S027 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 1994
Winston Medical CenterLouisville, MS, CCN 250027 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 1994
Winston Medical CenterLouisville, MS, CCN 255072 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 1994
Winston Medical Clinic LLCLouisville, MS, CCN 258593 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 6, 2012
Nov 6, 2012
Winston Medical Clinic-NoxapaterNoxapater, MS, CCN 258594 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 6, 2012
Nov 6, 2012
Winston Medical Clinic Main StreetLouisville, MS, CCN 258623 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2015
Jul 1, 2015

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319500800000",
    "number": "1518098367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 967",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393390967",
            "telephone_number": "662-773-6211",
            "fax_number": "662-773-6211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 E MAIN ST",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393392742",
            "telephone_number": "662-779-5101",
            "fax_number": "662-773-6223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINSTON COUNTY MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2011-10-25",
        "status": "A",
        "authorized_official_last_name": "MCCALL",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-779-5102",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220250",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winston Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, MS

Sources for this page

Verify at the official NPI Registry.