Baptist Medical Center - Yazoo, Inc
Organization Active NPI Rural Health Clinic/Center · Yazoo City, MS
NPI 1699066746 · NPPES record last updated Sep 29, 2020
Key facts
- NPI
- 1699066746
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- BAPTIST MEDICAL CENTER - YAZOO, INC
- Practice address
- 823 Grand Ave
Yazoo City, MS 39194-3233 - Phone
- (662) 751-8289
- NPI assigned
- Apr 25, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- BAPTIST MEMORIAL HEALTH CARE CORP.
Authorized official
- Name
- Gregory M Duckett
- Title
- Sr VP/Clo
- Phone
- (901) 227-5233
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 47
Practitioners 13
-
Sarah Spencer Walker, BC-C
-
Eric Ryan Woods, DO
-
Walter M Burnett, M.D.
-
James Darnell McIntyre, CFNP
-
Allison Wynne McQuirter, CFNP
-
Melinda G Richards, FNP
-
Leslie Brooke Robinson, CFNP
-
Jenna Kay Cole, FNP-BC
-
Kayla Barnett Ferguson, FNP-C
-
Allison Patterson, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
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
- Corporation · Non-profit
- Incorporated
- Apr 20, 1994 in MS
- Enrollment address
- 823 Grand Ave
Yazoo City, MS 39194-3233 - Related CCNs
- 251313
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Jason M Little |
Corporate Officer |
Dec 10, 2020 | |
| Corporate Director |
Dec 10, 2020 | ||
| Gary C Anderson |
Corporate Director |
Feb 1, 2015 | |
| Kurt W Metzner |
Corporate Director |
Feb 1, 2015 | |
| Arthur Maples |
Corporate Director | Jan 1, 2018 | |
| Van K Ray |
Corporate Director |
Feb 1, 2015 | |
| Dennis McFee |
Corporate Director |
Feb 23, 2021 | |
| Robert Coleman |
W-2 Managing Employee |
Jan 1, 2019 | |
| Baptist Medical Center - Yazoo, Inc. |
5% Or Greater Direct Ownership Interest | Apr 25, 2011 | 100% |
| Gregory M Duckett |
Corporate Officer |
May 1, 2017 | |
| Cobie Collins |
Corporate Director |
Dec 10, 2020 | |
| William Griffin |
Corporate Officer |
May 1, 2017 | |
| William F Thompson |
Corporate Director |
Feb 1, 2015 | |
| Mississippi Baptist Health Systems, Inc |
5% Or Greater Direct Ownership Interest | Feb 1, 2015 | 100% |
| Baptist Memorial Health Care Corporation |
5% Or Greater Indirect Ownership Interest | May 1, 2017 | 100% |
| Julie M Hoffman |
Corporate Director |
Feb 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Baptist Memorial Health Care Corp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 19965 | MS | |
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
823 Grand Ave
Yazoo City, MS 39194-3233
Mailing address
350 N Humphreys Blvd
Memphis, TN 38120-2177
Other names
- BMC YAZOO PRIMARY CARE
Other providers in Yazoo City, MS
- Robert John Andrews
- Lucy Dixon Bain
- Christy Coward Baker
- Baptist Medical Center - Yazoo, Inc
- Baptist Medical Center - Yazoo, Inc
- Alanna Bass
- Lauren E Beard
- Hailey Parks Beckwith
- Bella Med LLC
- Bio-Medical Applications of Mississippi, Inc.
All providers in Yazoo City, 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 Sep 29, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.