NPIMap

Organization Active NPI

City of Jackson Health Care Authority

  • Medicare Defined Swing Bed Hospital Unit
  • Jackson, AL
National Provider Identifier
1558487397
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H1302 Issued in AL
Legal business name
CITY OF JACKSON HEALTH CARE AUTHORITY
Practice address
220 Hospital Dr
Jackson, AL 36545-2459
Phone
(251) 246-9021
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Authorized official

Name
Jennifer Ryland
Title
Ceo
Phone
(251) 246-9021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H1302 AL Primary

Addresses

Primary practice location

220 Hospital Dr
Jackson, AL 36545-2459

Mailing address

220 Hospital Dr
Jackson, AL 36545-2459

Other identifiers 1

IdentifierTypeStateIssuer
4791280SMedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240821005139 AL Part A Provider - Hospital 2062950199 Practice locations: Jackson, AL

Hospital certification: CCN 01U128

Legal name
CITY OF JACKSON HEALTHCARE AUTHORITY
Doing business as
JACKSON MEDICAL CENTER
Organization structure
OtherNon-profit
Enrollment address
220 Hospital Dr
Jackson, AL 36545-2459
Hospital Swing-Bed Unit
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 3

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

National Provider Directory

National Provider Directory
Tax ID family
City of Jackson Healthcare Authority3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73288
  • FHIR API: https://fhir-usa.unify.chbase.com/org/jackmed-17fd68d4
  • FHIR API: https://api.platform.athenahealth.com/14082/brand/1/csg/1/fhir/r4

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
Grady Bedwell Individual Corporate DirectorChairman / Dir Sep 30, 2024 33.33%
Bobby G Brooks Individual Corporate DirectorVice Chair / Board of Dir Sep 30, 2024 33.33%
Jennifer Ryland Individual W-2 Managing EmployeeAd; Sep 30, 2024
Hassell C Bouncd Individual Corporate DirectorAssist Sec / Assist Treasurer / Sep 30, 2024 33.33%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Jackson Medical Center Home HealthJackson, AL, CCN 017112 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 30, 2024
Sep 30, 2024
Family Medical Clinic of JacksonJackson, AL, CCN 013471 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2024

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1558487397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 HOSPITAL DR",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365452459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 HOSPITAL DR",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365452459",
            "telephone_number": "251-246-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF JACKSON HEALTH CARE AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2025-05-22",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "RYLAND",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "251-246-9021"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AL",
            "license": "H1302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4791280S",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, AL

Sources for this page

Verify at the official NPI Registry.