NPIMap

Organization Active NPI

Simpson Community Healthcare Inc.

Doing business as SGH Drive-Thru Clinic

  • Rural Health Clinic/Center
  • Mendenhall, MS
National Provider Identifier
1619630001
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SIMPSON COMMUNITY HEALTHCARE INC.
Doing business as
SGH Drive-Thru Clinic
Practice address
1827A Simpson Highway 149
Mendenhall, MS 39114-3439
Phone
(601) 847-7130
NPI assigned
Oct 21, 2021
Last updated
Oct 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SIMPSON COMMUNITY HEALTHCARE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Shelly G. Riley
Title
Sr Accountant
Phone
(601) 847-7130

Specialties & licenses 1

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

Addresses

Primary practice location

1827A Simpson Highway 149
Mendenhall, MS 39114-3439

Mailing address

1827A Simpson Highway 149
Mendenhall, MS 39114-3439
Phone (601) 847-7130

Other names 1

  • SGH Drive-Thru Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211129001757 MS Part A Provider - Rural Health Clinic 5991709750 Practice locations: Mendenhall, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619630001. Details of each certification follow.

Rural health clinic certification: CCN 258664

Legal name
SIMPSON COMMUNITY HEALTHCARE, INC.
Doing business as
SGH DRIVE THRU CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 15, 2021
Last certification
Dec 15, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 2005 in MS
Enrollment address
1827A Simpson Highway 149
Mendenhall, MS 39114
Related CCNs
251317

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

Other NPIs with the same Medicare PAC ID 6

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

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
25D2239451SGH Drive Thru Clinic1827A Simpson Hwy 149, Mendenhall, MS 39114Certificate of waiverOct 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Simpson Community Hlthcare11 organizations share this tax ID, including this one
Part of
Simpson Community Hlthcare

Other organizations with this tax ID 10

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

Member organizations 1

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

Locations

1652 Simpson Highway 469
Harrisville, MS 39082
Phone (601) 847-7784

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Shelly G. Riley Individual W-2 Managing Employee Sep 18, 1997
Simpson Community Healthcare, Inc. Organization, Mendenhall, MS Corporation, Non-profit Operational/Managerial Control Jan 1, 2021 100%
Gregg Gibbes Individual Corporate OfficerCeo Jul 1, 2020 100%

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
SGH Medical ClinicMendenhall, MS, CCN 258557 Rural health clinic Operational/Managerial Control (100%) Jul 20, 2006
Puckett Medical ClinicBrandon, MS, CCN 258606 Rural health clinic Operational/Managerial Control (100%) May 1, 2014

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1619630001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1827A SIMPSON HIGHWAY 149",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143439",
            "telephone_number": "601-847-7130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1827A SIMPSON HIGHWAY 149",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143439",
            "telephone_number": "601-847-7130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPSON COMMUNITY HEALTHCARE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIMPSON COMMUNITY HEALTHCARE INC.",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "SR ACCOUNTANT",
        "authorized_official_telephone_number": "601-847-7130"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SGH Drive-Thru Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mendenhall, MS

Sources for this page

Verify at the official NPI Registry.