NPIMap

Organization Active NPI

Covington County Hospital

Doing business as Medical Center of Magee

  • Rural Health Clinic/Center
  • Magee, MS
National Provider Identifier
1750895611
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COVINGTON COUNTY HOSPITAL
Doing business as
Medical Center of Magee
Thomas R. Blackledge, Jr. MD PA Medical Center of Magee
Practice address
800 3Rd St SW
Magee, MS 39111-3951
Phone
(601) 849-1918
Fax
(601) 849-1908
NPI assigned
Nov 29, 2017
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Anissa L Evans
Title
Medical Staff Coordinator
Phone
(601) 765-3180

Specialties & licenses 1

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

Addresses

Primary practice location

800 3Rd St SW
Magee, MS 39111-3951

Mailing address

701 S Holly Ave
Collins, MS 39428-3894
Phone (601) 849-1918

Other names 2

  • Medical Center of Magee Doing business as
  • Thomas R. Blackledge, Jr. MD PA Medical Center of Magee Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180131000789 MS Part A Provider - Rural Health Clinic 4183517253 Practice locations: Magee, MS
O20190517001731 MS Part B Supplier - Clinic/Group Practice 4183517253 Receives reassigned benefits from 24 practitioners
Practice locations: Magee, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750895611. Details of each certification follow.

Rural health clinic certification: CCN 258597

Legal name
COVINGTON COUNTY HOSPITAL
Doing business as
CCH CLINIC MAGEE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 2, 2019
Last certification
Jul 2, 2019
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
800 3Rd St SW
Magee, MS 39111-3951
Related CCNs
251325

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
James McPhail Individual Corporate OfficerBoard Member Jan 15, 2009 25%
Corporate DirectorBoard Member Jan 15, 2009 25%
Covington County Hospital Organization, Collins, MS 5% Or Greater Direct Ownership Interest Mar 1, 2018 100%
Operational/Managerial Control Mar 1, 2018 100%
Robert Johnson Individual Corporate OfficerPresident Jan 23, 2007
Corporate DirectorPresident Jan 23, 2007
Greg Sullivan Individual Corporate OfficerBoard Member Jan 15, 2008 25%
Corporate DirectorBoard Member Jan 15, 2008 25%
Gregg Gibbes Individual Corporate OfficerChief Executive Officer Oct 14, 2014
W-2 Managing EmployeeChief Executive Officer Nov 14, 2014
Everlean Booth Individual Corporate Officer Nov 18, 2005 25%
Corporate DirectorSecretary Nov 18, 2005 25%

Owners & managing parties with NPI records 15

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

  • Covington County Hospital

    dba Smith County EH Pro Fees

    • Emergency Medical Services (Emergency Medicine) Physician
    • Raleigh, MS
    • NPI 1003654567

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Family Care Express

    • Rural Health Clinic/Center
    • Collins, MS
    • NPI 1013205350

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Smith County Emergency Hospital

    • Rural Acute Care Hospital
    • Raleigh, MS
    • NPI 1043051543

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Arrington Living Center

    • Skilled Nursing Facility
    • Collins, MS
    • NPI 1053615518

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba CCH Clinic Seminary

    • Rural Health Clinic/Center
    • Seminary, MS
    • NPI 1134435498

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital
    • Critical Access Hospital
    • Collins, MS
    • NPI 1215965249

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital
    • Psychiatric Hospital Unit
    • Collins, MS
    • NPI 1225150436

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Family Care Magee Tuscan Towers

    • Rural Health Clinic/Center
    • Magee, MS
    • NPI 1225704208

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba CCH Clinic Taylorsville

    • Rural Health Clinic/Center
    • Taylorsville, MS
    • NPI 1306460282

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Green Tree Family Medical Clinic

    • Rural Health Clinic/Center
    • Mount Olive, MS
    • NPI 1336447861

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Family Care Magee

    • Rural Health Clinic/Center
    • Magee, MS
    • NPI 1346822772

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covington County Hospital

    dba Family Care of Main Street

    • Rural Health Clinic/Center
    • Collins, MS
    • NPI 1518260330

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
View all 15

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Covington County HospitalCollins, MS, CCN 25M325 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2016
Arrington Living CenterCollins, MS, CCN 255331 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2011
May 1, 2011
Family Medical AssociatesCollins, MS, CCN 253497 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2016
Family Care ExpressCollins, MS, CCN 258562 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2016
Jan 1, 2016
Express Care SumrallSumrall, MS, CCN 258644 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Family Care of MageeMagee, MS, CCN 258662 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 4, 2021
Jan 4, 2021
Family Care Magee Tuscan TowersMagee, MS, CCN 258660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 1, 2021
Sep 1, 2021

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1750895611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 S HOLLY AVE",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "394283894",
            "telephone_number": "601-849-1918",
            "fax_number": "601-849-1908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 3RD ST SW",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113951",
            "telephone_number": "601-849-1918",
            "fax_number": "601-849-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-29",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ANISSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEDICAL STAFF COORDINATOR",
        "authorized_official_telephone_number": "601-765-3180"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center of Magee",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Thomas R. Blackledge, Jr. MD PA Medical Center of Magee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Magee, MS

Sources for this page

Verify at the official NPI Registry.