NPIMap

Organization Active NPI

Baptist Memorial Hospital-Desoto, Inc.

  • Rehabilitation Hospital Unit
  • Southaven, MS
National Provider Identifier
1972560654
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
13318 Issued in MS
Legal business name
BAPTIST MEMORIAL HOSPITAL-DESOTO, INC.
Practice address
7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone
(662) 349-4001
NPI assigned
Apr 27, 2006
Last updated
Oct 1, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
Gregory Duckett
Title
Sr VP/ Clo
Phone
(901) 227-5233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 13318 MS Primary

Addresses

Primary practice location

7601 Southcrest Pkwy
Southaven, MS 38671-4739

Mailing address

350 N Humphreys Blvd
Memphis, TN 38120-2177
Phone (662) 349-4001

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040405001337 MS Part B Supplier - Clinic/Group Practice 5597758755 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Southaven, MS
O20080716000036 MS Part A Provider - Hospital 5597758755 Practice locations: Southaven, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972560654. Details of each certification follow.

Hospital certification: CCN 25T141

Legal name
BAPTIST MEMORIAL HOSPITAL-DESOTO, INC.
Doing business as
BMH - DESOTO
Organization structure
CorporationProprietary
Incorporated
Aug 25, 1982 in MS
Enrollment address
7601 Southcrest Parkway
Southaven, MS 38671-4739
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Baptist Hospital DesotoCCN 25T141 · All quality measures
Ownership
For profit
Certified
Jan 1, 1994

National Provider Directory

National Provider Directory
Tax ID family
Baptist Mem Hospital4 organizations share this tax ID, including this one
Part of
Baptist Memorial Health Care Corp

Other organizations with this tax ID 3

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

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
Jason M Little Individual Corporate OfficerVP Jan 14, 2013
Cary M. Finn Individual Corporate DirectorBoard Member Aug 20, 2020
Gary C Anderson Individual Corporate OfficerVice President Jan 1, 2025
Arthur Maples Individual Corporate DirectorDelegated Official Dec 15, 2020
Paul Cade Individual W-2 Managing EmployeeAd; Jan 1, 2024
Kris Azlin Individual Corporate DirectorBoard Member Jan 1, 2025
Arie Szatkowski Individual Corporate DirectorBoard Member Aug 20, 2020
Gregory M Duckett Individual Corporate OfficerSr VP/Corp Sec Jan 1, 2000
Dale L Morris Individual Corporate DirectorBoard Member Aug 20, 2020
Riad I Homsi Individual Corporate DirectorBoard Member Aug 20, 2020
Brian Hogan Individual W-2 Managing EmployeeManaging Employee Aug 20, 2020
Baptist Memorial Health Care Corporation Organization, Memphis, TN Non-profit 5% Or Greater Direct Ownership Interest Aug 25, 1982

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 47

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

View all 47

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1972560654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177",
            "telephone_number": "662-349-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 SOUTHCREST PKWY",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714739",
            "telephone_number": "662-349-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAPTIST MEMORIAL HOSPITAL-DESOTO, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2006-04-27",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "SR VP/ CLO",
        "authorized_official_telephone_number": "901-227-5233"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MS",
            "license": "13318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.