Kemper, Cah, Inc.
Organization Active NPI Rural Health Clinic/Center · Marion, MS
NPI 1669812962 · NPPES record last updated Apr 26, 2023
Key facts
- NPI
- 1669812962
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- KEMPER, CAH, INC.
- Practice address
- 5334 Dale Dr
Marion, MS 39342-9604 - Phone
- (601) 703-0130
- Fax
- (601) 703-0133
- NPI assigned
- Jul 1, 2013
- Organization subpart
- No
Authorized official
- Name
- Don Larkin Kennedy
- Title
- Regional Ceo
- Phone
- (601) 703-9614
Owners & managing parties with NPI records 1
-
Johnathan Lee, M.D.
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 6
Related certifications (CCN) 1
Facilities with the same owner 28
Practitioners 36
-
Brelan Mikal Gardner, FNP
-
Jessica Reynolds, FNP-C
-
Lasaundra Roberts, APMHNP-BC
-
Doris Nicole Bradley, FNP-BC
-
Brandon J Craft, NP
-
Tiffany Dearman, FNP
-
Jessica Hardy, FNP
-
Deborah A Hester, MD
-
Patsy Lenan Holloway, FNP BC
-
Jennifer P Lafferty, FNP
-
Kari Moore, FNP
-
Rhonda Moore, AGPCNP-BC
-
Vanessa Norman, AGPCNP
-
John Payne, MD
-
Elizabeth A. Stokes, FNP
-
Kimberly Ann Topping, NURSE PRACTITIONER
-
Jessica S. Vaughan, ACNP
-
Daniel Lee Armistead, M.D.
-
Erica A Diggs, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2027097 | Ochsner Health Center - Marion | Certificate of waiver | Nov 30, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Rural health clinic certification: CCN 258565
- Legal name
- KEMPER CAH, INC.
- Doing business as
- OCHSNER HEALTH CENTER-MARION
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 18, 2012
- Last certification
- Mar 24, 2026
- Ownership / control type
- 2B
- Most recent change of ownership
- Aug 1, 2013 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 29, 2008 in MS
- Enrollment address
- 5334 Dale Dr
Marion, MS 39342-9604 - Related CCNs
- 251335
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Johnathan Y Lee |
Corporate Officer |
Jul 1, 2022 | |
| Corporate Director |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Kristin K. Molony |
W-2 Managing Employee |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Michael F Hulefeld |
Corporate Officer |
Nov 1, 2022 | |
| Corporate Director |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Faye Martin |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Ochsner Clinic Foundation |
5% Or Greater Indirect Ownership Interest | Jul 1, 2022 | 100% |
| Operational/Managerial Control | Jul 1, 2022 | ||
| Alan Gartrell |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Peter C November |
Corporate Officer |
Nov 1, 2022 | |
| Corporate Director |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| James M Molloy |
Corporate Officer |
Jan 1, 2024 | |
| Darrell Wildman |
Corporate Director |
Jul 1, 2022 | |
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Don L Kennedy |
Corporate Officer |
Jul 1, 2022 | |
| W-2 Managing Employee |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 | ||
| Rush Health Systems Inc |
5% Or Greater Direct Ownership Interest | Jul 1, 2022 | 100% |
| Operational/Managerial Control | Aug 1, 2013 | ||
| David L Butler |
Corporate Officer |
Jul 1, 2022 | |
| W-2 Managing Employee |
Jul 1, 2022 | ||
| Operational/Managerial Control |
Jul 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110622000294 | MS | Part B Supplier - Clinic/Group Practice | 5991985012 |
Receives reassigned benefits from 92 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: De Kalb, MS; Marion, MS; Meridian, MS |
| O20130828000753 | MS | Part a Provider - Rural Health Clinic | 5991985012 | Practice locations: Marion, MS |
National Provider Directory
Locations
5334 Dale Dr
Marion, MS 39342
Phone (601) 703-0130
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
5334 Dale Dr
Marion, MS 39342-9604
Mailing address
Dept 3019, P O Box 1000
Memphis, TN 38148-3019
Phone (601) 213-3010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000939715 | Medicaid | MS |
Other names
- Ochsner Health Center-Marion
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Marion, MS
- Guardian Angel Healthcare, Inc.
- Jill Hickman
- Lauren Reece Hill
- Inner Images Consulting LLC
- Tracie Lynn Johnson
- Jennifer P Lafferty
- Marion Discount Drugs
- Marion Health and Rehab, LLC
- Elizabeth McKenzie
- Tanika Renae Mitchell
All providers in Marion, MS · Rural Health Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.