NPIMap

Organization Active NPI

Rush Medical Foundation

  • Rural Health Clinic/Center
  • Meridian, MS
National Provider Identifier
1811233950
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RUSH MEDICAL FOUNDATION
Practice address
905C S Frontage Rd
Meridian, MS 39301-6113
Phone
(601) 482-4955
Fax
(601) 482-4957
NPI assigned
Dec 18, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Authorized official

Name
Don Larkin Kennedy
Title
Regional Ceo
Phone
(601) 703-9614

Specialties & licenses 1

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

Addresses

Primary practice location

905C S Frontage Rd
Meridian, MS 39301-6113

Mailing address

Dept 3027 P O Box 1000
Memphis, TN 38148-3027
Phone (601) 213-3010

Other identifiers 1

IdentifierTypeStateIssuer
009014894MedicaidMS

Other names 1

  • Ochsner Urgent Care-Meridian Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031210000541 MS Part B Supplier - Clinic/Group Practice 2567368541 Receives reassigned benefits from 96 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Meridian, MS; Quitman, MS
O20130418000536 MS Part A Provider - Rural Health Clinic 2567368541 Practice locations: Meridian, MS

Rural health clinic certification: CCN 253986

Legal name
RUSH MEDICAL FOUNDATION
Doing business as
OCHSNER URGENT CARE-MERIDIAN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 1993
Last certification
Oct 21, 2019
Ownership / control type
2B
Most recent change of ownership
Feb 1, 2013 (3 total)
Organization structure
CorporationNon-profit
Incorporated
Jul 27, 2006 in MS
Enrollment address
905C S Frontage Rd
Meridian, MS 39301-6113
Related CCNs
251316

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

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 6

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

905C S Frontage Rd
Meridian, MS 39301
Phone (601) 482-4955

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Johnathan Y Lee Individual Corporate DirectorGoverning Board,Rush Health Systems Jul 1, 2022
Operational/Managerial ControlGoverning Board,Rush Health Systems Jul 1, 2022
Michael F Hulefeld Individual Corporate OfficerPresident, Coo Nov 1, 2022
Corporate DirectorMember of Governing Board Jul 1, 2022
Operational/Managerial ControlMember of Governing Board Jul 1, 2022
Faye Martin Individual Corporate DirectorGoverning Board,Rush Health Systems Jul 1, 2022
Operational/Managerial ControlGoverning Board,Rush Health Systems Jul 1, 2022
Alan Gartrell Individual Corporate DirectorGoverning Board,Rush Health Systems Jul 1, 2022
Operational/Managerial ControlGoverning Board,Rush Health Systems Jul 1, 2022
Peter C November Individual Corporate OfficerChief Executive Officer Nov 1, 2022
Corporate DirectorMember of Governing Board Jul 1, 2022
Operational/Managerial ControlMember of Governing Board Jul 1, 2022
Kawanda C Johnson Individual W-2 Managing EmployeeAdministrator Jan 1, 2024
Operational/Managerial ControlAdministrator Jan 1, 2024
James M Molloy Individual Corporate OfficerExecutive VP, Cfo, Treasurer Jan 1, 2024
Darrell Wildman Individual Corporate DirectorGoverning Board,Rush Health Systems Jul 1, 2022
Operational/Managerial ControlGoverning Board,Rush Health Systems Jul 1, 2022
Ochsner Clinic Foundation Organization, New Orleans, LA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2022 100%
Operational/Managerial Control Jul 1, 2022
Don L Kennedy Individual Corporate OfficerRegional Chief Executive Officer Jul 1, 2022
W-2 Managing EmployeeRegional Chief Executive Officer,Ru Jul 1, 2022
Operational/Managerial ControlRegional Chief Executive Officer,Ru Jul 1, 2022
Rush Health Systems Inc Organization, Meridian, MS Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Jul 1, 2022 100%
Operational/Managerial Control Feb 1, 2013
David L Butler Individual Corporate OfficerChief Financial Officer,Rush Health Jul 1, 2022
W-2 Managing EmployeeChief Financial Officer,Rush Health Jul 1, 2022
Operational/Managerial ControlChief Financial Officer,Rush Health Jul 1, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Ochsner Scott RegionalMorton, MS, CCN 251323 Hospital 5% Or Greater Mortgage Interest (100%) Jan 1, 2020
Ochsner Rush Medical CenterMeridian, MS, CCN 250069 Hospital 5% Or Greater Direct Ownership Interest Dec 15, 1966
Ochsner Stennis HospitalDe Kalb, MS, CCN 251335 Hospital 5% Or Greater Mortgage Interest Jan 1, 2020
Ochsner Stennis Hospital Swing BedDe Kalb, MS, CCN 25Z335 Hospital 5% Or Greater Mortgage Interest (100%) Jan 1, 2020
Ochsner Choctaw GeneralButler, AL, CCN 011304 Hospital 5% Or Greater Mortgage Interest (100%) Jan 1, 2020
Ochsner Laird HospitalUnion, MS, CCN 251322 Hospital 5% Or Greater Mortgage Interest (100%) Jan 1, 2020
Ochsner Watkins HospitalQuitman, MS, CCN 251316 Hospital 5% Or Greater Mortgage Interest (100%) Jan 1, 2020

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 75

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

View all 75

Practitioners 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1811233950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 3027 P O BOX 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381483027",
            "telephone_number": "601-213-3010",
            "fax_number": "601-213-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905C S FRONTAGE RD",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393016113",
            "telephone_number": "601-482-4955",
            "fax_number": "601-482-4957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSH MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-18",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "DON",
        "authorized_official_middle_name": "LARKIN",
        "authorized_official_title_or_position": "REGIONAL CEO",
        "authorized_official_telephone_number": "601-703-9614"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009014894",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Ochsner Urgent Care-Meridian",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.