King'S Daughters Medical Center
Organization Active NPI General Acute Care Hospital · Brookhaven, MS
NPI 1972503464 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1972503464
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 16235 (MS)
- Legal business name
- KING'S DAUGHTERS MEDICAL CENTER
- Practice address
- 427 Highway 51 N
Brookhaven, MS 39601-2350 - Phone
- (601) 833-6011
- Fax
- (601) 833-5210
- NPI assigned
- Jul 26, 2005
- Organization subpart
- No
Authorized official
- Name
- Scott Christensen
- Title
- Chief Executive Officer
- Phone
- (601) 835-9488
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 5
Related certifications (CCN) 3
Practitioners 142
-
Amanda Leah Barry, ACNP
-
Leslie Lewis Barry, NP-C
-
Ellanie L Bessonette, AGACNP
-
Ryland Boehnke, DO
-
David Steven Braden, M.D.
-
Holly M Bridges, CFNP
-
Blaine Cooper Britt, M.D.
-
Robert B Britt, M.D
-
Stephen Jeffrey Brown, D.O.
-
William Graham Carter, FNP-C
-
Meghan Lynn Case, MD
-
Saloum Cisse, M.D.
-
Roger C Clapp Jr., M.D.
-
Candice Nicole Cliburn, NURSE PRACTITIONER
-
Simmons T Copeland, N.P.
-
Sean Maurice Debuysere, D.O.
-
Tammy Lofton Dixon, FNP
-
Paul G Dykes, MD
-
Karla Adams Gerald, FNP
-
Cheryl Lynn Gladney, M.D.
-
Amber Goodman, PA-C
-
Cole Timmons Hodges, D.O.
Affiliated clinicians 303
-
Aja Abai, M.D.
-
Gerald Todd Adcock, CRNA
-
Marcenia Aldridge, CNFP
-
Victor Anazia, DO
-
Jeffrey Ross Anderson, D.O.
-
Amanda Wynne Atwood, CFNP
-
Justin T Baker, M.D.
-
Deanna Danell Ballard, C.F.N.P.
-
Sheena Renee Barnes, FNP
-
Austin McNees Barrett, M.D.
-
Mark Timothy Barron, M.D.
-
Amanda Leah Barry, ACNP
-
Leslie Lewis Barry, NP-C
-
Jennifer Oberschmidt Bass, FNP-C
-
William Paul Berlin Jr., M.D.
-
Ellanie L Bessonette, AGACNP
-
Imad Bitar, MD
Medicare Care Compare: Hospital
- Listed as
- King'S Daughters Medical Center-Brookhaven
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Other
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Hospital certification: CCN 250057
- Legal name
- KINGS DAUGHTERS MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Sep 3, 1966
- Last certification
- Mar 14, 1991
- Beds
- 122 (112 certified)
- Ownership / control type
- Other
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 427 Highway 51 N
Brookhaven, MS 39601-2350 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Scott Christensen |
Corporate Officer |
Aug 1, 2022 | |
| Operational/Managerial Control |
Aug 1, 2022 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| King'S Daughters Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 2024 Jan 1, 2024 |
| King'S Daughters Primary Care Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 2024 Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041028000174 | MS | Part B Supplier - Clinic/Group Practice | 3072575539 |
Receives reassigned benefits from 149 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brookhaven, MS |
| O20071217000823 | MS | Part a Provider - Hospital | 3072575539 | Practice locations: Brookhaven, MS |
National Provider Directory
Locations
940 Brookway Blvd
Brookhaven, MS 39601
Phone (601) 823-5000
1024 D a Biglane Dr
Brookhaven, MS 39601
Phone (601) 823-8000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 16235 | MS | Yes |
| Ambulance | 341600000X |
Addresses
Primary practice location
427 Highway 51 N
Brookhaven, MS 39601-2350
Mailing address
427 Highway 51 N
Brookhaven, MS 39601-2350
Phone (601) 833-6011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000019008 | Other | MS | PROF SERV KINGS DAUGHTERS |
| CC3386 | Other | MS | MEDICARE RR-TRAVLERS |
| 00020008 | Medicaid | MS |
Other providers in Brookhaven, MS
- King'S Daughters Medical Center
- King'S Daughters Medical Center
- King'S Daughters Medical Center
- King'S Daughters Medical Center
- King'S Daughters Medical Center
- King'S Daughters OB-GYN Clinic
- Kings Daughters Medical Center
- Catherine W. Knott
- L & L Homecare Agency LLC
- John Cordeaux Lambert
All providers in Brookhaven, MS · General Acute Care Hospital in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.