NPIMap

Organization Active NPI

Southwest Mississippi Regional Medical Center

Doing business as Premier Medical Clinic

  • Rural Health Clinic/Center
  • McComb, MS
National Provider Identifier
1962451831
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Doing business as
Premier Medical Clinic
Southwest Primary Care
Practice address
1506 Aston Ave
McComb, MS 39648-2735
Phone
(601) 249-4415
Fax
(601) 249-4474
NPI assigned
May 9, 2006
Last updated
Feb 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

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

Authorized official

Name
Mrs. Charla Rowley
Title
Ceo
Phone
(601) 249-1806

Specialties & licenses 1

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

Addresses

Primary practice location

1506 Aston Ave
McComb, MS 39648-2735

Mailing address

PO Box 490
McComb, MS 39649-0490
Phone (601) 249-2701

Other identifiers 1

IdentifierTypeStateIssuer
07800828MedicaidMS

Other names 2

  • PREMIER MEDICAL CLINIC Doing business as
  • Southwest Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080512000004 MS Part B Supplier - Clinic/Group Practice 5193633907 Receives reassigned benefits from 86 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McComb, MS; Summit, MS; Monticello, MS
O20120411000727 MS Part A Provider - Rural Health Clinic 5193633907 Practice locations: McComb, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962451831. Details of each certification follow.

Rural health clinic certification: CCN 258567

Legal name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Doing business as
SOUTHWEST PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 19, 2012
Last certification
Jul 23, 2019
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Enrollment address
1506 Aston Ave
McComb, MS 39648-2735
Related CCNs
250097

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

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 22

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

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Smrmc Dba SW Internal M35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Locations

1318 Harrison Ave
McComb, MS 39648
Phone (601) 684-2300

212 Marion Ave
McComb, MS 39648
Phone (601) 249-1570

215 Marion Ave
Fl 5
McComb, MS 39648
Phone (601) 249-1719

300 Rawls Dr
Ste 1200
McComb, MS 39648
Phone (601) 249-4282

300 Rawls Dr
Ste I
McComb, MS 39648
Phone (601) 249-4710

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Mallory Ginn Individual Corporate DirectorDir of Revnue Cycle Nov 28, 2012
Southwest Mississippi Regional Medical Center Organization, McComb, MS 5% Or Greater Direct Ownership Interest Feb 1, 2012
Angela M Weems Individual W-2 Managing Employee Jun 27, 2012
Charla Rowley Individual Corporate OfficerCeo Apr 17, 2014

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
St. Luke Home Health and HospiceMcComb, MS, CCN 257124 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Oct 1, 2001
St. Luke Home Health and HospiceMonticello, MS, CCN 251687 Hospice 5% Or Greater Indirect Ownership Interest (100%) Feb 22, 2002
Womens Health CenterMcComb, MS, CCN 258642 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2019
Nov 1, 2019
Lawrence County Board of SupervisorsMonticello, MS, CCN 258692 Rural health clinic Operational/Managerial Control Sep 27, 2001

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 46

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 46

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1962451831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396490490",
            "telephone_number": "601-249-2701",
            "fax_number": "601-249-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 ASTON AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482735",
            "telephone_number": "601-249-4415",
            "fax_number": "601-249-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A",
        "authorized_official_last_name": "ROWLEY",
        "authorized_official_first_name": "CHARLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-249-1806",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07800828",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIER MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McComb, MS

Sources for this page

Verify at the official NPI Registry.