NPIMap

Organization Active NPI

Baptist Memorial Hospital - Golden Triangle Inc.

Doing business as Baptist Behavioral Health Care-Golden Triangle

  • Psychiatric Hospital Unit
  • Columbus, MS
National Provider Identifier
1609963479
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
18871 Issued in MS
Legal business name
BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE INC.
Doing business as
Baptist Behavioral Health Care-Golden Triangle
Practice address
2520 5TH St N
Columbus, MS 39705-2008
Phone
(662) 244-2561
Fax
(662) 244-2575
NPI assigned
Oct 5, 2006
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Gregory M Duckett
Title
Sr VP/ Clo
Phone
(901) 227-5233

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 16253 MS
Psychiatric Hospital Unit 273R00000X 18871 MS Primary

Addresses

Primary practice location

2520 5TH St N
Columbus, MS 39705-2008

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177

Other identifiers 2

IdentifierTypeStateIssuer
000020205OtherMSBCBS PROV NUMBER
09013691MedicaidMS

Other names 1

  • Baptist Behavioral Health Care-Golden Triangle Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070306000062 MS Part A Provider - Hospital 1456244623 Practice locations: Columbus, MS
O20101116000167 MS Part B Supplier - Clinic/Group Practice 1456244623 Receives reassigned benefits from 44 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tupelo, MS; Starkville, MS; Columbus, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609963479. Details of each certification follow.

Hospital certification: CCN 25S100

Legal name
BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE INC
Doing business as
BMH - GOLDEN TRIANGLE
Organization structure
CorporationNon-profit
Incorporated
Jan 28, 1993 in MS
Enrollment address
2520 5TH St N
Columbus, MS 39705-2008
Other Hospital Practice Location
Hospital subgroups
Psychiatric unit

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Baptist Memorial Health Care Corp

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jason M Little Individual Corporate OfficerPresident Jan 14, 2013
Raymond Waters Individual Corporate DirectorBoard Member, Chair Jan 1, 2007
Jeff Farnham Individual Corporate DirectorBoard Member Jan 1, 2025
Gary C Anderson Individual Corporate OfficerVice President Jan 1, 2025
Dennis Erby Individual Corporate DirectorBoard Member Feb 26, 2021
Arthur Maples Individual Corporate DirectorDelegated Official Feb 26, 2021
Donnie Davis Individual Corporate DirectorBoard Member Apr 1, 2004
Robert Coleman Individual W-2 Managing EmployeeCeo May 1, 2023
Gregory M Duckett Individual Corporate OfficerExecutive Vice President Jan 1, 2000
Allen Puckett Individual Corporate DirectorBoard Member Dec 1, 2004
Baptist Memorial Health Care Corporation Organization, Memphis, TN Non-profit 5% Or Greater Indirect Ownership Interest Jan 28, 1993 100%
Joel a Butler Individual Corporate DirectorBoard Member Jan 14, 2013

Owners & managing parties with NPI records 1

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

Facilities with the same owner 47

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

View all 47

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1609963479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052008",
            "telephone_number": "662-244-2561",
            "fax_number": "662-244-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR VP/ CLO",
        "authorized_official_telephone_number": "901-227-5233"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MS",
            "license": "16253",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MS",
            "license": "18871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROV NUMBER",
            "identifier": "000020205",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013691",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baptist Behavioral Health Care-Golden Triangle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baptist Behavioral Health Care-Golden Triangle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, MS

Sources for this page

Verify at the official NPI Registry.