NPIMap

Organization Active NPI

Scott Regional Medical Center, Inc.

Doing business as Ochsner Health Center- Forest

  • Rural Health Clinic/Center
  • Forest, MS
National Provider Identifier
1679831531
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SCOTT REGIONAL MEDICAL CENTER, INC.
Doing business as
Ochsner Health Center- Forest
Practice address
1080 Highway 35 S
Forest, MS 39074-9423
Phone
(601) 469-3555
Fax
(601) 469-3584
NPI assigned
Apr 30, 2012
Last updated
Apr 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

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

Authorized official

Name
Don Larkin Kennedy
Title
Regional Ceo
Phone
(601) 703-9614

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

1080 Highway 35 S
Forest, MS 39074-9423

Mailing address

Dept 3029 PO Box 1000
Memphis, TN 38148-3029
Phone (601) 213-3010

Other identifiers 1

IdentifierTypeStateIssuer
002838364MedicaidMS

Other names 1

  • Ochsner Health Center- Forest Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080423000448 MS Part B Supplier - Clinic/Group Practice 0648366260 Receives reassigned benefits from 57 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Forest, MS; Lake, MS; Morton, MS

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 53

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.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1679831531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 3029 PO BOX 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381483029",
            "telephone_number": "601-213-3010",
            "fax_number": "601-213-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 HIGHWAY 35 S",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390749423",
            "telephone_number": "601-469-3555",
            "fax_number": "601-469-3584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT REGIONAL MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-30",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "DON",
        "authorized_official_middle_name": "LARKIN",
        "authorized_official_title_or_position": "REGIONAL CEO",
        "authorized_official_telephone_number": "601-703-9614"
    },
    "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
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002838364",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ochsner Health Center- Forest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.