NPIMap

Organization Active NPI

Medical Systems Management LLC

Doing business as Rankin Rural Medical Clinic

  • Rural Health Clinic/Center
  • Richland, MS
National Provider Identifier
1740555267
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEDICAL SYSTEMS MANAGEMENT LLC
Doing business as
Rankin Rural Medical Clinic
Practice address
129 Center St Ste B
Richland, MS 39218-4800
Phone
(601) 992-9898
NPI assigned
Mar 16, 2012
Last updated
Jun 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Authorized official

Name
Edwin Blair Marble
Title
President
Phone
(769) 233-7141

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

129 Center St Ste B
Richland, MS 39218-4800

Mailing address

129 Center St Ste B
Richland, MS 39218-4800
Phone (601) 992-9898

Other names 1

  • Rankin Rural Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120926000104 MS Part A Provider - Rural Health Clinic 5092964643 Practice locations: Richland, MS
O20131024001113 MS Part B Supplier - Clinic/Group Practice 5092964643 Receives reassigned benefits from 45 practitioners
Practice locations: Richland, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740555267. Details of each certification follow.

Rural health clinic certification: CCN 253861

Legal name
MEDICAL SYSTEMS MANAGEMENT, LLC
Doing business as
RANKIN RURAL MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 28, 2012
Last certification
Jul 29, 2019
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
May 19, 2011 in MS
Enrollment address
129 Center Street
Suite B
Richland, MS 39218-4800

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2046590Rankin Rural Medical Clinic129 Center St Ste B, Richland, MS 39218Certificate of waiverSep 5, 2026

National Provider Directory

National Provider Directory
Tax ID family
Medical Systems Management2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

129 Center St
Ste B
Richland, MS 39218
Phone (769) 233-7141

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Medical Systems Management, LLC Organization, Richland, MS 5% Or Greater Direct Ownership Interest Jun 29, 2013
Robert Crawford Individual 5% Or Greater Direct Ownership Interest Sep 1, 2015
General Partnership Interest Jun 29, 2013
Edwin B Marble Individual Contracted Managing Employee Sep 1, 2015
5% Or Greater Direct Ownership Interest Sep 1, 2015
General Partnership Interest Aug 21, 2012
Stephen S Crawford Individual 5% Or Greater Direct Ownership Interest Sep 1, 2015
General Partnership Interest Jun 17, 2016

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1740555267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 CENTER ST STE B",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "392184800",
            "telephone_number": "601-992-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 CENTER ST STE B",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "392184800",
            "telephone_number": "601-992-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SYSTEMS MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "MARBLE",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "BLAIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "769-233-7141"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rankin Rural Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rankin Rural Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richland, MS

Sources for this page

Verify at the official NPI Registry.