NPIMap

Baptist Medical Center-Leake, Inc

Organization Active NPI Rural Health Clinic/Center · Walnut Grove, MS

NPI 1649546342 · NPPES record last updated Oct 15, 2025

Key facts

NPI
1649546342
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
BAPTIST MEDICAL CENTER-LEAKE, INC
Practice address
17509 Highway 21
Walnut Grove, MS 39189-6505
Phone
(601) 267-1320
NPI assigned
Mar 27, 2012
Organization subpart
Yes
Parent organization (as reported)
BAPTIST MEMORIAL HEALTH CARE CORP.

Authorized official

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

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.

Owners & managing parties with NPI records 4

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

Owned or controlled facilities with NPI records 3

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

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 6

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 47

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

View all 47

Practitioners 19

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Rural health clinic certification: CCN 258589

Legal name
BAPTIST MEDICAL CENTER-LEAKE, INC.
Doing business as
BMC LEAKE SEBASTOPOL PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 10, 2013
Last certification
Dec 15, 2021
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Nov 1, 2011 in MS
Enrollment address
17509 Highway 21
Walnut Grove, MS 39189-6505
Related CCNs
251315

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 Officer
President		 Dec 10, 2020
Corporate Director
Board Member		 Dec 10, 2020
Arthur Maples
Individual 		Corporate Director Jan 1, 2019
Daryl W Weaver
Individual 		W-2 Managing Employee
Ceo		 Feb 23, 2021
Arthur Jernigan
Individual 		Corporate Director
Board Member		 Feb 23, 2021
Gregory M Duckett
Individual 		Corporate Officer
Sr VP/Clo		 Feb 23, 2021
Mikki Ogletree
Individual 		Corporate Director
Board Member		 Dec 10, 2020
Baptist Medical Center-Leake, Inc.
Organization · Carthage, MS
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Nov 1, 2012 100%
5% Or Greater Security Interest Nov 1, 2012 100%
Jeff Webb
Individual 		Corporate Director
Board Member		 Jan 1, 2019
Marcus Mann
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Mississippi Baptist Health Systems, Inc
Organization · Jackson, MS
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Nov 1, 2012 100%
Brian Pickens
Individual 		Corporate Director
Board Member		 Dec 10, 2020
Baptist Memorial Health Care Corporation
Organization · Memphis, TN
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest May 1, 2017 100%

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Baptist Medical Center-Leake, Inc.
Carthage, MS · CCN 25Z315		 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2011
Baptist Medical Center-Leake, Inc.
Carthage, MS · CCN 251315		 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2011
BMC Leake Carthage Primary Care
Carthage, MS · CCN 258508		 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 1, 2011
BMC Leake Walnut Grove Primary Care
Walnut Grove, MS · CCN 258536		 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 1, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120112000444 MS Part B Supplier - Clinic/Group Practice 7214102961 Receives reassigned benefits from 29 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carthage, MS; Madden, MS; Walnut Grove, MS
O20140225001687 MS Part a Provider - Rural Health Clinic 7214102961 Practice locations: Walnut Grove, MS

National Provider Directory

Tax ID family
Baptist Medical Center-Leake Inc (7 organizations share this tax ID)
Part of
Baptist Memorial Health Care Corp

Locations

17509 Highway 21
Walnut Grove, MS 39189
Phone (601) 267-1320

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X

Addresses

Primary practice location

17509 Highway 21
Walnut Grove, MS 39189-6505

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177
Phone (601) 267-1320

Other names

  • BMC LEAKE SEBASTOPOL PRIMARY CARE Doing business as
  • BMC Leake Madden Primary Care Doing business as

Other providers in Walnut Grove, MS

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

Sources for this page

Verify at the official NPI Registry.