NPIMap

Organization Active NPI

Jasper General Hospital

  • Family Medicine Physician
  • Bay Springs, MS
National Provider Identifier
1770660920
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
00115455 Issued in MS
Legal business name
JASPER GENERAL HOSPITAL
Practice address
20 S Sixth St
Bay Springs, MS 39422-9055
Phone
(601) 764-4494
Fax
(601) 764-4649
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Authorized official

Name
Mr. Marshall Kenneth Posey
Title
Administrator
Phone
(601) 764-2101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 00115455 MS Primary

Addresses

Primary practice location

20 S Sixth St
Bay Springs, MS 39422-9055

Mailing address

20 S Sixth St
Bay Springs, MS 39422-9055
Phone (601) 764-4494

Other identifiers 4

IdentifierTypeStateIssuer
09010972MedicaidMS
04-30099OtherMSUNITED HEALTH CARE
425136982BOtherMSBLUE CROSS
80088201OtherMSMEDICARE RAILROAD

Other names 1

  • FAMILY MEDICAL CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130115000077 MS Part B Supplier - Clinic/Group Practice 1052487105 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
Practice locations: Bay Springs, MS

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Pro Care Home HealthBay Springs, MS, CCN 257096 Home health agency 5% Or Greater Direct Ownership Interest (100%) Dec 1, 1975
Jasper County After Hours ClinicBay Springs, MS, CCN 258643 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2020

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1770660920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 S SIXTH ST",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394229055",
            "telephone_number": "601-764-4494",
            "fax_number": "601-764-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 S SIXTH ST",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394229055",
            "telephone_number": "601-764-4494",
            "fax_number": "601-764-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASPER GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "POSEY",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-764-2101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "00115455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09010972",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "04-30099",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "425136982B",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "80088201",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bay Springs, MS

Sources for this page

Verify at the official NPI Registry.