NPIMap

Organization Active NPI

Noxubee General Critical Access Hospital

Doing business as Macon Primary Care Clinic

  • Rural Health Clinic/Center
  • Macon, MS
National Provider Identifier
1790872018
Registry record updated Dec 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Doing business as
Macon Primary Care Clinic
Practice address
78 Hospital Rd
Macon, MS 39341-2490
Phone
(662) 726-4264
Fax
(662) 726-4204
NPI assigned
Oct 6, 2006
Last updated
Dec 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2025

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

Authorized official

Name
Mr. Danny H McKay
Title
Administrator
Phone
(662) 726-4231

Specialties & licenses 1

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

Addresses

Primary practice location

78 Hospital Rd
Macon, MS 39341-2490

Mailing address

PO Box 480
Macon, MS 39341-0480
Phone (662) 726-4264

Other identifiers 1

IdentifierTypeStateIssuer
09014786MedicaidMS

Other names 1

  • Macon Primary Care 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
O20040524000515 MS Part B Supplier - Clinic/Group Practice 9335130798 Receives reassigned benefits from 24 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Macon, MS
O20100525000951 MS Part A Provider - Rural Health Clinic 9335130798 Practice locations: Macon, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790872018. Details of each certification follow.

Rural health clinic certification: CCN 253487

Legal name
NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
Doing business as
MACON PRIMARY CARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 1998
Last certification
Oct 19, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
78 Hospital Rd
Macon, MS 39341-2490

Other NPIs with the same Medicare PAC ID 6

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.

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
25D0907082Macon Primary Care Clinic Inc78 Hospital Road, Macon, MS 39341Provider-performed microscopyJan 2, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Margaret Ebert Individual Corporate Director Jul 7, 2020
W-2 Managing Employee Jul 7, 2020

Practitioners & affiliated clinicians

Practitioners 1

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766102400000",
    "number": "1790872018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 480",
            "city": "MACON",
            "state": "MS",
            "postal_code": "393410480",
            "telephone_number": "662-726-4264",
            "fax_number": "662-726-4204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 HOSPITAL RD",
            "city": "MACON",
            "state": "MS",
            "postal_code": "393412490",
            "telephone_number": "662-726-4264",
            "fax_number": "662-726-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A",
        "authorized_official_last_name": "MCKAY",
        "authorized_official_first_name": "DANNY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-726-4231",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014786",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macon Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macon, MS

Sources for this page

Verify at the official NPI Registry.