NPIMap

Organization Active NPI

Forrest County General Hospital

Doing business as Jefferson Davis General Hospital

  • Family Medicine Physician
  • Prentiss, MS
National Provider Identifier
1730452558
Registry record updated Feb 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FORREST COUNTY GENERAL HOSPITAL
Doing business as
Jefferson Davis General Hospital
Practice address
1102 Rose St
Prentiss, MS 39474-5200
Phone
(601) 792-4276
Fax
(601) 792-2947
NPI assigned
Feb 10, 2012
Last updated
Feb 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2012

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

Authorized official

Name
Richard Andrew Woodard
Title
Cfo
Phone
(601) 288-2892

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X

Addresses

Primary practice location

1102 Rose St
Prentiss, MS 39474-5200

Mailing address

1102 Rose St
Prentiss, MS 39474-5200
Phone (601) 792-4276

Other names 1

  • Jefferson Davis General Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624001351 MS Part B Supplier - Clinic/Group Practice 1052397767 Receives reassigned benefits from 246 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Prentiss, MS; Poplarville, MS; Hattiesburg, MS; Picayune, MS; Laurel, MS; Columbia, MS

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Forrest Cty Gen Hosp41 organizations share this tax ID, including this one

Other organizations with this tax ID 40

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

View all 40

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328832000000",
    "number": "1730452558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 ROSE ST",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "394745200",
            "telephone_number": "601-792-4276",
            "fax_number": "601-792-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 ROSE ST",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "394745200",
            "telephone_number": "601-792-4276",
            "fax_number": "601-792-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORREST COUNTY GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2012-02-10",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-288-2892"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Davis General Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prentiss, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.