NPIMap

Organization Active NPI

Mississippi Baptist Medical Center, Inc.

  • General Acute Care Hospital
  • Jackson, MS
National Provider Identifier
1710909585
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
14-281 Issued in MS
Legal business name
MISSISSIPPI BAPTIST MEDICAL CENTER, INC.
Practice address
1225 N State St
Jackson, MS 39202-2064
Phone
(601) 968-1000
Fax
(601) 968-1383
NPI assigned
Jul 24, 2006
Last updated
Sep 30, 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 30, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 14-281 MS Primary

Addresses

Primary practice location

1225 N State St
Jackson, MS 39202-2064

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071211000169 MS Part A Provider - Hospital 9234026600 Practice locations: Jackson, MS; Madison, MS; Flowood, MS
O20110707000181 MS Part B Supplier - Clinic/Group Practice 9234026600 Receives reassigned benefits from 157 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710909585. Details of each certification follow.

Hospital certification: CCN 250102

Legal name
MISSISSIPPI BAPTIST MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Aug 1, 1969
Last certification
Mar 3, 2000
Beds
639
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1996 in MS
Enrollment address
1225 N State St
Jackson, MS 39202-2064
Other Hospital Practice Location
Hospital subgroups
General, Acute care

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mississippi Baptist Medical CenterCCN 250102 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Joe W Terry Jr11 organizations share this tax ID, including this one
Part of
Baptist Memorial Hospital-North Mississippi

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 16

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 OfficerOfficer President Jan 1, 2020
Corporate Director Jan 1, 2020
Karlen Turbeville Individual Corporate DirectorBoard Member May 1, 2017
Tammy H Young Individual Corporate DirectorMember-Board of Directors May 1, 2017
Douglas M Buckles Individual Corporate DirectorBoard Member May 1, 2017
Gary C Anderson Individual Corporate Officer Mar 18, 2014
Paul W Calhoun Individual Corporate DirectorBoard Member May 1, 2017
Arthur Maples Individual Corporate DirectorSystem Director Reg Plan & Policy Aug 21, 2020
Alveno N Castilla Individual Corporate DirectorBoard Member May 1, 2017
Robert Gathings Individual Corporate DirectorBoard Member May 1, 2017
Arthur Jernigan Individual Corporate DirectorBoard Member May 1, 2017
Gregory M Duckett Individual Corporate OfficerEvp Clo May 2, 2017
Lee D Miller Individual Corporate DirectorBoard of Directors Member May 1, 2017
Mississippi Baptist Health Systems, Inc Organization, Jackson, MS Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 1996 100%
Operational/Managerial Control Sep 1, 1996 100%
Baptist Memorial Health Care Corporation Organization, Memphis, TN Non-profit 5% Or Greater Indirect Ownership Interest May 1, 2017 100%
Philip Gunn Individual Corporate DirectorBoard Member Aug 13, 2020
Bobbie K Ware Individual Corporate OfficerCeo Jan 1, 2015
W-2 Managing EmployeeCeo Jan 1, 2015

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mississippi Homecare / JacksonJackson, MS, CCN 257082 Home health agency 5% Or Greater Direct Ownership Interest (33%) Mar 1, 2009
Baptist HospiceYazoo City, MS, CCN 251676 Hospice 5% Or Greater Indirect Ownership Interest (33%) Jun 1, 2017

Owned or controlled facilities with NPI records 2

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

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 78

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.

View all 78

Affiliated clinicians 925

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

View all 925

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1710909585",
    "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": "1225 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022064",
            "telephone_number": "601-968-1000",
            "fax_number": "601-968-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI BAPTIST MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2006-07-24",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MS",
            "license": "14-281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.