NPIMap

Organization Active NPI

Yalobusha General Hospital

  • General Acute Care Hospital
  • Water Valley, MS
National Provider Identifier
1649397308
Registry record updated Jul 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
11-223 Issued in MS
Legal business name
YALOBUSHA GENERAL HOSPITAL
Practice address
630 South Main Street
Water Valley, MS 38965-3468
Phone
(662) 473-1411
Fax
(662) 473-4922
NPI assigned
Mar 26, 2007
Last updated
Jul 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2010

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

Authorized official

Name
Mr. Terry Varner
Title
Administrator
Phone
(662) 473-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 11-223 MS Primary

Addresses

Primary practice location

630 South Main Street
Water Valley, MS 38965-3468

Mailing address

630 South Main Street
Water Valley, MS 38965-3468
Phone (662) 473-1411

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100616000893 AR Part A Provider - Hospital 4486601648 Practice locations: Ridgeland, MS; Water Valley, MS; Oxford, MS; Meridian, MS; Okolona, MS; Duncan, MS; Clinton, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649397308. Details of each certification follow.

Hospital certification: CCN 250061

Legal name
YALOBUSHA GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 1, 1966
Last certification
Jan 24, 2024
Beds
32
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
630 South Main St
Water Valley, MS 38965-3468
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Yalobusha General HospitalCCN 250061 · All quality measures
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Yalobusha General Hosp16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

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
Jessica Embry Individual Corporate Officer Jan 26, 2020
Corporate Director Jan 26, 2020
W-2 Managing Employee Jan 26, 2020
Kimberly Wilburn Individual W-2 Managing EmployeeBusiness Office Manager Jan 1, 2015
Yalobusha General Hospital Organization, Water Valley, MS 5% Or Greater Direct Ownership Interest Sep 1, 1966

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Yalobusha General Hospital Swing BedWater Valley, MS, CCN 25U061 Hospital 5% Or Greater Direct Ownership Interest Sep 12, 1985
Odom Rural Health ClinicWater Valley, MS, CCN 258538 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2007
Oakland Medical ClinicOakland, MS, CCN 258585 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2013
Arrington Medical ClinicCoffeeville, MS, CCN 258598 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 10, 2014

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 5

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.

Affiliated clinicians 54

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277942400000",
    "number": "1649397308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 SOUTH MAIN STREET",
            "city": "WATER VALLEY",
            "state": "MS",
            "postal_code": "389653468",
            "telephone_number": "662-473-1411",
            "fax_number": "662-473-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 SOUTH MAIN STREET",
            "city": "WATER VALLEY",
            "state": "MS",
            "postal_code": "389653468",
            "telephone_number": "662-473-1411",
            "fax_number": "662-473-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YALOBUSHA GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2010-07-01",
        "status": "A",
        "authorized_official_last_name": "VARNER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-473-1411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MS",
            "license": "11-223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Water Valley, MS

Sources for this page

Verify at the official NPI Registry.