NPIMap

Organization Active NPI

Covington County Hospital

Doing business as CCH Clinic Family Medical

  • Rural Health Clinic/Center
  • Collins, MS
National Provider Identifier
1598769044
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COVINGTON COUNTY HOSPITAL
Doing business as
CCH Clinic Family Medical
Practice address
301 Hospital Blvd
Collins, MS 39428-4225
Phone
(601) 765-3180
Fax
(601) 765-2808
NPI assigned
Jun 10, 2005
Last updated
May 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Anissa L Evans
Title
Credentialing Director
Phone
(601) 698-0328

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

301 Hospital Blvd
Collins, MS 39428-4225

Mailing address

P.O. Box 2499
Collins, MS 39428-2499
Phone (601) 765-3180

Other identifiers 2

IdentifierTypeStateIssuer
09015963MedicaidMS
25D0864691OtherMSCLIA

Other names 1

  • CCH Clinic Family Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080722000557 MS Part B Supplier - Clinic/Group Practice 4183517253 Receives reassigned benefits from 33 practitioners
3 other NPIs on this enrollment
Practice locations: Collins, MS
O20100812001175 MS Part A Provider - Rural Health Clinic 4183517253 Practice locations: Collins, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598769044. Details of each certification follow.

Rural health clinic certification: CCN 253497

Legal name
COVINGTON COUNTY HOSPITAL
Doing business as
FAMILY MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2002
Last certification
Mar 4, 2021
Ownership / control type
Non-profit – church related
Most recent change of ownership
Jan 2, 2002 (1 total)
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 1951 in MS
Enrollment address
701 S Holly Avenue
Family Medical Associates
Collins, MS 39428-3894

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0864691CCH Clinic Family Medical301 Hospital Blvd, Collins, MS 39428Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Greg Sanford Individual Corporate DirectorBoard Member Jan 15, 2008 100%
Operational/Managerial ControlBoard Member Jan 15, 2008 100%
James McPhail Individual Corporate DirectorBoard Member Jan 15, 2009 100%
Operational/Managerial ControlBoard Member Jan 15, 2009 100%
Covington County Hospital Organization, Collins, MS Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2016 100%
Charlie Anglin Individual Corporate DirectorBoard Member Oct 8, 2007 100%
Operational/Managerial ControlBoard Member Oct 8, 2007 100%
Robert Johnson Individual Corporate DirectorBoard Member-President Jan 23, 2007 100%
Operational/Managerial ControlBoard Member-President Jan 23, 2007 100%
Greg Sullivan Individual Corporate DirectorBoard Member Oct 8, 2007 100%
Operational/Managerial ControlBoard Member Oct 8, 2007 100%
Missy L Gamber Individual Contracted Managing EmployeeContracted to Provider Credentia Aug 1, 2014
Gregg Gibbes Individual Corporate OfficerCeo Apr 28, 2016 100%
W-2 Managing EmployeeCeo Apr 28, 2016 100%
Operational/Managerial ControlCeo Apr 28, 2016 100%
Everlean Booth Individual Corporate DirectorBoard Member-Secretary Nov 18, 2005 100%
Operational/Managerial ControlBoard Member-Secretary Nov 18, 2005 100%

Owners & managing parties with NPI records 15

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

View all 15

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Covington County HospitalCollins, MS, CCN 25M325 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2016
Arrington Living CenterCollins, MS, CCN 255331 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2011
May 1, 2011
Family Care ExpressCollins, MS, CCN 258562 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2016
Jan 1, 2016
CCH Clinic MageeMagee, MS, CCN 258597 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 1, 2018
Mar 1, 2018
Express Care SumrallSumrall, MS, CCN 258644 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Family Care of MageeMagee, MS, CCN 258662 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 4, 2021
Jan 4, 2021
Family Care Magee Tuscan TowersMagee, MS, CCN 258660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 1, 2021
Sep 1, 2021

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1598769044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2499",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394282499",
            "telephone_number": "601-765-3180",
            "fax_number": "601-765-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HOSPITAL BLVD",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394284225",
            "telephone_number": "601-765-3180",
            "fax_number": "601-765-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ANISSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "601-698-0328"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015963",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "25D0864691",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCH Clinic Family Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Collins, MS

Sources for this page

Verify at the official NPI Registry.