NPIMap

Organization Active NPI

Tishomingo Health Services, Inc.

Doing business as Burnsville Medical Clinic

  • Rural Health Clinic/Center
  • Burnsville, MS
National Provider Identifier
1770938979
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
13-221 Issued in MS
Legal business name
TISHOMINGO HEALTH SERVICES, INC.
Doing business as
Burnsville Medical Clinic
Practice address
296 Highway 72
Burnsville, MS 38833-9104
Phone
(662) 427-2073
Fax
(662) 427-2074
NPI assigned
Apr 26, 2016
Last updated
Jul 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Authorized official

Name
Bruce J Toppin
Title
Chief Legal Officer
Phone
(662) 377-4229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 13-221 MS Primary

Addresses

Primary practice location

296 Highway 72
Burnsville, MS 38833-9104

Mailing address

456 E President Ave
Tupelo, MS 38801-5515
Phone (662) 377-4685

Other names 1

  • Burnsville 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
O20040122000374 MS Part B Supplier - Clinic/Group Practice 2466354303 Receives reassigned benefits from 36 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Belmont, MS; Burnsville, MS; Iuka, MS
O20220826001417 MS Part A Provider - Rural Health Clinic 2466354303 Practice locations: Burnsville, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770938979. Details of each certification follow.

Rural health clinic certification: CCN 258671

Legal name
TISHOMINGO HEALTH SERVICES, INC.
Doing business as
BURNSVILLE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 28, 2022
Last certification
Dec 28, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1986 in DE
Enrollment address
296 Highway 72
Burnsville, MS 38833-9104
Related CCNs
250002

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).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Tishomingo Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

322 Highway 72
Burnsville, MS 38833

367 Highway 72
Burnsville, MS 38833

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Arthur E Gaines Individual Corporate DirectorBoard Member Oct 1, 2016
Jenna McNatt Individual Corporate DirectorBoard Member Oct 1, 2021
Tishomingo Health Services, Inc. Organization, Iuka, MS Corporation, Non-profit Operational/Managerial Control Nov 21, 1986 100%
North Mississippi Health Services Inc Organization, Tupelo, MS Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 21, 1986 100%
Bruce J Toppin Individual Corporate OfficerSecretary Jan 29, 1996
Daniel H Castile Individual Corporate DirectorBoard Member Jul 1, 2017
Sharon D Nobles Individual Corporate DirectorTreasurer Mar 13, 2017
James F Tennyson Individual Corporate DirectorChairman of the Board Oct 1, 2014
Barry L Keel Individual W-2 Managing EmployeeAdministrator Nov 30, 2020
Michael S Spees Individual Corporate OfficerPresident Feb 1, 2014
Steve McAnally Individual Corporate DirectorBoard Member Jun 1, 2011

Owners & managing parties with NPI records 3

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

Facilities with the same owner 33

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

View all 33

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1770938979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "456 E PRESIDENT AVE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388015515",
            "telephone_number": "662-377-4685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 HIGHWAY 72",
            "city": "BURNSVILLE",
            "state": "MS",
            "postal_code": "388339104",
            "telephone_number": "662-427-2073",
            "fax_number": "662-427-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TISHOMINGO HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-26",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "TOPPIN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "662-377-4229"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MS",
            "license": "13-221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Burnsville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burnsville, MS

Sources for this page

Verify at the official NPI Registry.