NPIMap

Organization Active NPI

Baptist Medical Center - Yazoo, Inc

Doing business as BMC Yazoo Primary Care

  • Rural Health Clinic/Center
  • Yazoo City, MS
National Provider Identifier
1699066746
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BAPTIST MEDICAL CENTER - YAZOO, INC
Doing business as
BMC Yazoo Primary Care
Practice address
823 Grand Ave
Yazoo City, MS 39194-3233
Phone
(662) 751-8289
NPI assigned
Apr 25, 2011
Last updated
Sep 29, 2020By 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 Sep 29, 2020

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
Specialist 174400000X 19965 MS

Addresses

Primary practice location

823 Grand Ave
Yazoo City, MS 39194-3233

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177

Other names 1

  • BMC YAZOO 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
O20080815000433 MS Part B Supplier - Clinic/Group Practice 5799850376 Receives reassigned benefits from 44 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yazoo City, MS
O20150908000271 MS Part A Provider - Rural Health Clinic 5799850376 Practice locations: Yazoo City, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699066746. Details of each certification follow.

Rural health clinic certification: CCN 258591

Legal name
BAPTIST MEDICAL CENTER - YAZOO, INC.
Doing business as
BAPTIST MEDICAL GROUP- YAZOO PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 31, 2014
Last certification
Jul 7, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 20, 1994 in MS
Enrollment address
823 Grand Ave
Yazoo City, MS 39194-3233
Related CCNs
251313

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Baptist Memorial Health Care Corp

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 15

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
Gary C Anderson Individual Corporate DirectorBoard Member Feb 1, 2015
Kurt W Metzner Individual Corporate DirectorBoard Member Feb 1, 2015
Arthur Maples Individual Corporate Director Jan 1, 2018
Van K Ray Individual Corporate DirectorBoard Member Feb 1, 2015
Dennis McFee Individual Corporate DirectorBoard Member Feb 23, 2021
Robert Coleman Individual W-2 Managing EmployeeCeo Jan 1, 2019
Baptist Medical Center - Yazoo, Inc. Organization, Yazoo City, MS Medical provider/supplier 5% Or Greater Direct Ownership Interest Apr 25, 2011 100%
Gregory M Duckett Individual Corporate OfficerSr VP/Clo May 1, 2017
Cobie Collins Individual Corporate DirectorBoard Member Dec 10, 2020
William Griffin Individual Corporate OfficerCfo May 1, 2017
William F Thompson Individual Corporate DirectorBoard Member Feb 1, 2015
Mississippi Baptist Health Systems, Inc Organization, Jackson, MS Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2015 100%
Baptist Memorial Health Care Corporation Organization, Memphis, TN Corporation, Non-profit 5% Or Greater Indirect Ownership Interest May 1, 2017 100%
Julie M Hoffman Individual Corporate DirectorBoard Member Feb 1, 2015

Owners & managing parties with NPI records 2

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

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 8

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": "1303689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1699066746",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 GRAND AVE",
            "city": "YAZOO CITY",
            "state": "MS",
            "postal_code": "391943233",
            "telephone_number": "662-751-8289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEDICAL CENTER - YAZOO, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2011-04-25",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "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": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "19965",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMC YAZOO PRIMARY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yazoo City, MS

Sources for this page

Verify at the official NPI Registry.