NPIMap

Organization Active NPI

Progressive Health of Houston, LLC

Doing business as Progressive Health Clinic of Okolona

  • Rural Health Clinic/Center
  • Okolona, MS
National Provider Identifier
1720845100
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PROGRESSIVE HEALTH OF HOUSTON, LLC
Doing business as
Progressive Health Clinic of Okolona
Practice address
518 West Dr
Okolona, MS 38860-1624
Phone
(662) 447-6170
NPI assigned
Mar 4, 2024
Last updated
Jul 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
Robert Quentin Whitwell Jr., JD
Title
Ceo
Phone
(662) 701-9346

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

518 West Dr
Okolona, MS 38860-1624

Mailing address

PO Box 432
Houston, MS 38851-0432
Phone (662) 447-6170

Other names 1

  • Progressive Health Clinic of Okolona Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240604002663 MS Part A Provider - Rural Health Clinic 0143662429 Practice locations: Okolona, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720845100. Details of each certification follow.

Rural health clinic certification: CCN 253417

Legal name
PROGRESSIVE HEALTH OF HOUSTON LLC
Doing business as
PROGRESSIVE HEALTH CLINIC OF OKOLONA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 21, 1994
Last certification
Jul 23, 2025
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
518 West Dr
Okolona, MS 38860-1624
Related CCNs
250785

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).

National Provider Directory

National Provider Directory
Tax ID family
Progressive HLTH of Houston4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Robert Quentin Whitwell Individual 5% Or Greater Direct Ownership Interest Jan 22, 2024 100%
W-2 Managing Employee Jan 22, 2024 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Progressive Health Group of HoustonHouston, MS, CCN 250785 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2024

Owned or controlled facilities with NPI records 1

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

Change-of-ownership history 1

DateEventCounterparty
Jan 22, 2024 Change of OwnershipThis provider was the buyer Family Medical Clinic of OkolonaCCN 253417, MS, NPI 1134236870

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1720845100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 432",
            "city": "HOUSTON",
            "state": "MS",
            "postal_code": "388510432",
            "telephone_number": "662-447-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 WEST DR",
            "city": "OKOLONA",
            "state": "MS",
            "postal_code": "388601624",
            "telephone_number": "662-447-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE HEALTH OF HOUSTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "WHITWELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "QUENTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-701-9346",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Progressive Health Clinic of Okolona",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Progressive Health Clinic of Okolona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Okolona, MS

Sources for this page

Verify at the official NPI Registry.