NPIMap

Organization Active NPI

Baptist Medical Center-Leake, Inc

Doing business as BMC Leake Sebastopol Primary Care

  • Rural Health Clinic/Center
  • Walnut Grove, MS
National Provider Identifier
1649546342
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAPTIST MEDICAL CENTER-LEAKE, INC
Doing business as
BMC Leake Sebastopol Primary Care
BMC Leake Madden Primary Care
Practice address
17509 Highway 21
Walnut Grove, MS 39189-6505
Phone
(601) 267-1320
NPI assigned
Mar 27, 2012
Last updated
Oct 15, 2025By 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 Oct 15, 2025

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
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse Practitioner 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 2

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

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649546342. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Nov 1, 2011 in MS
Enrollment address
17509 Highway 21
Walnut Grove, MS 39189-6505
Related CCNs
251315

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Baptist Medical Center7 organizations share this tax ID, including this one
Part of
Baptist Memorial Health Care Corp

Other organizations with this tax ID 6

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

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 Dec 10, 2020
Corporate DirectorBoard Member Dec 10, 2020
Arthur Maples Individual Corporate Director Jan 1, 2019
Daryl W Weaver Individual W-2 Managing EmployeeCeo Feb 23, 2021
Arthur Jernigan Individual Corporate DirectorBoard Member Feb 23, 2021
Gregory M Duckett Individual Corporate OfficerSr VP/Clo Feb 23, 2021
Mikki Ogletree Individual Corporate DirectorBoard 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 DirectorBoard Member Jan 1, 2019
Marcus Mann Individual Corporate DirectorBoard 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 DirectorBoard 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%

Owners & managing parties with NPI records 4

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
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 CareCarthage, MS, CCN 258508 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 1, 2011
BMC Leake Walnut Grove Primary CareWalnut Grove, MS, CCN 258536 Rural health clinic 5% Or Greater Direct Ownership Interest Nov 1, 2011

Owned or controlled facilities with NPI records 3

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

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 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760486400000",
    "number": "1649546342",
    "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",
            "telephone_number": "601-267-1320",
            "fax_number": "601-267-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17509 HIGHWAY 21",
            "city": "WALNUT GROVE",
            "state": "MS",
            "postal_code": "391896505",
            "telephone_number": "601-267-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEDICAL CENTER-LEAKE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2012-03-27",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMC LEAKE SEBASTOPOL PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BMC Leake Madden Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Grove, MS

Sources for this page

Verify at the official NPI Registry.