NPIMap

Organization Active NPI

Clay County Medical Corporation

Doing business as Clay County Med Ctr - ER Phys

  • Emergency Care Clinic/Center
  • West Point, MS
National Provider Identifier
1578670972
Registry record updated Nov 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Care Clinic/CenterTaxonomy code 261QE0002X
License
13-312 Issued in MS
Legal business name
CLAY COUNTY MEDICAL CORPORATION
Doing business as
Clay County Med Ctr - ER Phys
Practice address
835 Medical Center Dr
West Point, MS 39773-9320
Phone
(662) 495-2128
Fax
(662) 495-2361
NPI assigned
Aug 23, 2006
Last updated
Nov 11, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
CLAY COUNTY MEDICAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 11, 2011

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

Authorized official

Name
Mr. Joseph A Reppert
Title
Cfo
Phone
(662) 377-3978

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Care Clinic/Center 261QE0002X 13-312 MS Primary

Addresses

Primary practice location

835 Medical Center Dr
West Point, MS 39773-9320

Mailing address

835 Medical Center Dr
West Point, MS 39773-9320
Phone (662) 495-2128

Other identifiers 2

IdentifierTypeStateIssuer
9013498MedicaidMS
000019079OtherMSBLUE CROSS

Other names 1

  • Clay County Med Ctr - ER Phys Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041119000718 MS Part B Supplier - Clinic/Group Practice 4789649609 Receives reassigned benefits from 98 practitioners
14 other NPIs on this enrollment
Practice locations: West Point, MS; Starkville, MS; Eupora, MS; Aberdeen, MS

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Clay Cty Med Corp18 organizations share this tax ID, including this one
Part of
Clay Cty Med Corp

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 98

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 98

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320969600000",
    "number": "1578670972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 MEDICAL CENTER DR",
            "city": "WEST POINT",
            "state": "MS",
            "postal_code": "397739320",
            "telephone_number": "662-495-2128",
            "fax_number": "662-495-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 MEDICAL CENTER DR",
            "city": "WEST POINT",
            "state": "MS",
            "postal_code": "397739320",
            "telephone_number": "662-495-2128",
            "fax_number": "662-495-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY COUNTY MEDICAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAY COUNTY MEDICAL CORPORATION",
        "enumeration_date": "2006-08-23",
        "last_updated": "2011-11-11",
        "status": "A",
        "authorized_official_last_name": "REPPERT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "662-377-3978",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "MS",
            "license": "13-312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9013498",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000019079",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clay County Med Ctr - ER Phys",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Point, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.