NPIMap

Organization Active NPI

South Central Regional Medical Center

  • Internal Medicine Physician
  • Laurel, MS
National Provider Identifier
1700934676
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11-153 Issued in MS
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Practice address
1220 Jefferson St
Laurel, MS 39440-4355
Phone
(601) 426-4000
Fax
(601) 399-6254
NPI assigned
Jan 8, 2007
Organization subpart
Yes
Parent organization
SOUTH CENTRAL REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

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

Authorized official

Name
Stephen East
Title
Cfo
Phone
(601) 399-6144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 11-153 MS Primary

Addresses

Primary practice location

1220 Jefferson St
Laurel, MS 39440-4355

Mailing address

PO Box 607
Laurel, MS 39441-0607
Phone (601) 426-4000

Other identifiers 2

IdentifierTypeStateIssuer
000019141OtherMSBLUE CROSS OF MS
09013315MedicaidMS

Other names 1

  • South Central Regional Medical Center-Cardiology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000259 MS Part B Supplier - Clinic/Group Practice 8325946411 Receives reassigned benefits from 17 practitioners
16 other NPIs on this enrollment
Practice locations: Laurel, MS

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
South Central Reg Med C27 organizations share this tax ID, including this one
Part of
South Central Reg Med C

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Jones County Rest HomeEllisville, MS, CCN 255336 Skilled nursing facility Operational/Managerial Control (100%) Apr 10, 2010
Comfort Care Nursing CenterLaurel, MS, CCN 255352 Skilled nursing facility Operational/Managerial Control (100%) Aug 1, 1994
Comfort Care Home HealthLaurel, MS, CCN 257099 Home health agency Operational/Managerial Control (100%) Jul 1, 1991
Comfort Care HospiceLaurel, MS, CCN 251512 Hospice Operational/Managerial Control (100%) Jul 18, 1992
South Central Family Medicine & Urgent CareLaurel, MS, CCN 258581 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2014
South Central PediatricsLaurel, MS, CCN 258510 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 14, 2012
Ellisville Pediatric ClinicEllisville, MS, CCN 253437 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 14, 2012
South Central Primary Care ServicesLaurel, MS, CCN 258649 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2020
South Central Urgent CareLaurel, MS, CCN 258688 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 2020
Jul 1, 2025

Owned or controlled facilities with NPI records 9

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

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752192000000",
    "number": "1700934676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410607",
            "telephone_number": "601-426-4000",
            "fax_number": "601-399-6254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404355",
            "telephone_number": "601-426-4000",
            "fax_number": "601-399-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "enumeration_date": "2007-01-08",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-399-6144"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "11-153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MS",
            "identifier": "000019141",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013315",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Central Regional Medical Center-Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.