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Simpson Community Healthcare Inc.

Organization Active NPI Rural Health Clinic/Center · Mendenhall, MS

NPI 1619630001 · NPPES record last updated Oct 21, 2021

Key facts

NPI
1619630001
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SIMPSON COMMUNITY HEALTHCARE INC.
Practice address
1827A Simpson Highway 149
Mendenhall, MS 39114-3439
Phone
(601) 847-7130
NPI assigned
Oct 21, 2021
Organization subpart
Yes
Parent organization (as reported)
SIMPSON COMMUNITY HEALTHCARE INC.

Authorized official

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

Owners & managing parties with NPI records 6

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

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 10

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

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

Facilities with the same owner 2

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

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2239451SGH Drive Thru Clinic
1827A Simpson Hwy 149, Mendenhall, MS 39114		Certificate of waiverOct 11, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

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
Corporation · Non-profit
Incorporated
Jan 4, 2005 in MS
Enrollment address
1827A Simpson Highway 149
Mendenhall, MS 39114
Related CCNs
251317

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 Officer
Ceo		 Jul 1, 2020 100%

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 Clinic
Mendenhall, MS · CCN 258557		 Rural health clinic Operational/Managerial Control (100%) Jul 20, 2006
Puckett Medical Clinic
Brandon, MS · CCN 258606		 Rural health clinic Operational/Managerial Control (100%) May 1, 2014

Medicare enrollment records

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

National Provider Directory

Tax ID family
Simpson Community Hlthcare (11 organizations share this tax ID)
Part of
Simpson Community Hlthcare

Locations

1827 Simpson Highway 149
#C
Mendenhall, MS 39114
Phone (601) 847-2100

Specialties & licenses

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

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

  • SGH Drive-Thru Clinic Doing business as

Other providers in Mendenhall, MS

All providers in Mendenhall, MS · Rural Health Clinic/Center in Mississippi

Sources for this page

Verify at the official NPI Registry.