NPIMap

Organization Active NPI

Simpson Community Healthcare Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Mendenhall, MS
National Provider Identifier
1689799207
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
13216 Issued in MS
Legal business name
SIMPSON COMMUNITY HEALTHCARE INC.
Practice address
1842 Simpson Highway 149
Mendenhall, MS 39114-3438
Phone
(601) 847-7130
Fax
(601) 847-7104
NPI assigned
Mar 20, 2007
Organization subpart
Yes
Parent organization
SIMPSON COUMMUNITY HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Authorized official

Name
Shelly Riley
Title
Cco Business Office Director
Phone
(601) 847-7130

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 13216 MS Primary

Addresses

Primary practice location

1842 Simpson Highway 149
Mendenhall, MS 39114-3438

Mailing address

1842 Simpson Highway 149
Mendenhall, MS 39114-3438
Phone (601) 847-7130

Other identifiers 1

IdentifierTypeStateIssuer
00029167MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080429000678 MS Part A Provider - Critical Access Hospital 5991709750 Practice locations: Mendenhall, MS

Hospital certification: CCN 25Z317

Legal name
SIMPSON COMMUNITY HEALTHCARE, INC.
Organization structure
CorporationProprietary
Incorporated
Jan 4, 2005 in MS
Enrollment address
1842 Simpson Hwy 149
Simpson General Hospital
Mendenhall, MS 39114-3438
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Simpson Community Hlthcare11 organizations share this tax ID, including this one
Part of
Simpson Community Hlthcare

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shelly G. Riley Individual W-2 Managing EmployeeCfo Jan 1, 2024 100%

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
SGH Medical ClinicMendenhall, MS, CCN 258557 Rural health clinic Operational/Managerial Control (100%) Jul 20, 2006
Puckett Medical ClinicBrandon, MS, CCN 258606 Rural health clinic Operational/Managerial Control (100%) May 1, 2014
SGH Drive Thru ClinicMendenhall, MS, CCN 258664 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 9

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

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1689799207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1842 SIMPSON HIGHWAY 149",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143438",
            "telephone_number": "601-847-7130",
            "fax_number": "601-847-7104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1842 SIMPSON HIGHWAY 149",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143438",
            "telephone_number": "601-847-7130",
            "fax_number": "601-847-7104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPSON COMMUNITY HEALTHCARE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIMPSON COUMMUNITY HEALTHCARE, INC.",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "RILEY",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CCO BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "601-847-7130"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MS",
            "license": "13216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00029167",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendenhall, MS

Sources for this page

Verify at the official NPI Registry.