NPIMap

State of Mississippi - University of Mississippi Medical Center

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Lexington, MS

NPI 1700872173 · NPPES record last updated Jun 26, 2008

Key facts

NPI
1700872173
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Practice address
239 Bowling Green Rd
Lexington, MS 39095-5167
Phone
(662) 834-1321
Fax
(601) 815-6301
NPI assigned
Sep 21, 2005
Organization subpart
No

Authorized official

Name
Mr. William Kennedy
Title
Director of Patient Financial Serv
Phone
(601) 984-4680

Owners & managing parties with NPI records 22

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

Owned or controlled facilities with NPI records 15

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

Other NPIs on the same Medicare enrollment 15

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

Other NPIs with the same Medicare PAC ID 22

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

Corporate family (same tax ID) 24

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

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

Facilities with the same owner 14

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 956

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

View all 956

Affiliated clinicians 2

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Hospital certification: CCN 25Z319

Legal name
STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Doing business as
UNIVERSITY OF MISSISSI MEDICAL CENTER- HOLMES COUNTY
Organization structure
Government · Non-profit
Enrollment address
239 Bowling Green Rd
Lexington, MS 39095-5167
Other Hospital Practice Location

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Jeffrey G Grimsley
Individual 		Corporate Officer
Health System Cfo		 May 1, 2015
W-2 Managing Employee May 1, 2015
State of Mississippi-University of Mississippi Medical Center
Organization · Jackson, MS
Non-profit 		5% Or Greater Direct Ownership Interest Jan 1, 2004

All facility ownership & control disclosures 14

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

FacilityTypeRoleSince
State of Mississippi-University of Mississippi Medical Center
Jackson, MS · CCN 250001		 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2007
Jul 1, 2007
Holmes County Hospital & Clinics
Lexington, MS · CCN 251319		 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2004
Ummc- Grenada
Grenada, MS · CCN 250168		 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 21, 2014
Feb 21, 2014
Ummc Madison
Canton, MS · CCN 250038		 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Ummc Madison
Canton, MS · CCN 25U038		 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Lexington Rural Health Clinic
Lexington, MS · CCN 253813		 Rural health clinic 5% Or Greater Direct Ownership Interest May 23, 2013
West Rural Health Clinic
West, MS · CCN 253812		 Rural health clinic 5% Or Greater Direct Ownership Interest May 22, 2013
Ummc- Grenada Women'S Services
Grenada, MS · CCN 258626		 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Holmes County Family Medicine Clinic- Vaiden
Vaiden, MS · CCN 258625		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2016
Ummc Grenada Specialty Pediatrics
Grenada, MS · CCN 258627		 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Children'S of Mississippi Greenwood Clinic
Greenwood, MS · CCN 258682		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Primary Care Clinic
Greenwood, MS · CCN 258679		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Women'S Clinic
Greenwood, MS · CCN 258680		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Grenada Primary Medicine Clinic
Grenada, MS · CCN 258681		 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080702000310 MS Part a Provider - Critical Access Hospital 1850293036 Practice locations: Lexington, MS
O20090414000575 MS Part B Supplier - Clinic/Group Practice 1850293036 Receives reassigned benefits from 1,922 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Sigurds O Krolls MD (62 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Yes

Addresses

Primary practice location

239 Bowling Green Rd
Lexington, MS 39095-5167

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (662) 834-1321

Other names

  • Holmes County Hospital and Clinic Doing business as

Other providers in Lexington, MS

All providers in Lexington, MS · Medicare Defined Swing Bed Hospital Unit in Mississippi

Sources for this page

Verify at the official NPI Registry.