NPIMap

Organization Active NPI

Choctaw Regional Medical Center

Doing business as Choctaw Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Ackerman, MS
National Provider Identifier
1518374875
Registry record updated Oct 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CHOCTAW REGIONAL MEDICAL CENTER
Doing business as
Choctaw Nursing and Rehabilitation Center
Practice address
311 W Cherry St
Ackerman, MS 39735-8708
Phone
(662) 285-6235
NPI assigned
Jul 18, 2014
Last updated
Oct 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2014

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

Authorized official

Name
Steve Montgomery
Title
Chancery Clerk
Phone
(662) 285-6329

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

311 W Cherry St
Ackerman, MS 39735-8708

Mailing address

PO Box 719
Ackerman, MS 39735-0719
Phone (662) 285-6235

Other identifiers 1

IdentifierTypeStateIssuer
01809271MedicaidMS

Other names 1

  • CHOCTAW NURSING AND REHABILITATION CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180709001397 MS Part A Provider - Skilled Nursing Facility 2567682206 Practice locations: Ackerman, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518374875. Details of each certification follow.

Skilled nursing facility certification: CCN 255347

Legal name
CHOCTAW REGIONAL MEDICAL CENTER
Doing business as
CHOCTAW NURSING AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 19, 2018
Last certification
Apr 18, 2024
Beds
60
Ownership / control type
County
Organization structure
GovernmentNon-profit
Enrollment address
311 W Cherry Street
Ackerman, MS 39775-8708
Nursing home name
CHOCTAW NURSING AND REHABILITATION CENTER

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Choctaw Nursing and Rehabilitation CenterCCN 255347 · All quality measures
Overall star rating
1 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Government - County
Certified
Oct 19, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6052.5 residents per day on average
Penalties (3 years)
2Fines totaling $12,472

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Choctaw Regional Medical Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

14724 Highway 15 N
Louisville, MS 39339
Phone (662) 773-7500

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
Steve Marinelli Individual Corporate OfficerCeo, Cfo Aug 1, 2020
Corporate DirectorCeo, Cfo Aug 1, 2020
Trilogy Healthcare Solutions LLC Organization, Madison, MS Management services company Operational/Managerial Control Aug 1, 2014 100%
Tammy Proctor Individual W-2 Managing EmployeeMedicare Billing Specialist Aug 31, 2016
Choctaw Regional Medical Center Organization, Ackerman, MS Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2014 100%

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Choctaw Regional Medical CenterAckerman, MS, CCN 251334 Hospital Other Aug 1, 2014
Choctaw Regional Medical CenterAckerman, MS, CCN 25Z334 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2014
Choctaw Medical ClinicAckerman, MS, CCN 258609 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2014
Louisville Medical ClinicLouisville, MS, CCN 258602 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2015
May 1, 2015

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 7

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.

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413763200000",
    "number": "1518374875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "ACKERMAN",
            "state": "MS",
            "postal_code": "397350719",
            "telephone_number": "662-285-6235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W CHERRY ST",
            "city": "ACKERMAN",
            "state": "MS",
            "postal_code": "397358708",
            "telephone_number": "662-285-6235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOCTAW REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-10-20",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CHANCERY CLERK",
        "authorized_official_telephone_number": "662-285-6329"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01809271",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHOCTAW NURSING AND REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ackerman, MS

Sources for this page

Verify at the official NPI Registry.