NPIMap

Organization Active NPI

Copiah County Medical Center

  • Rural Health Clinic/Center
  • Crystal Springs, MS
National Provider Identifier
1972603819
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COPIAH COUNTY MEDICAL CENTER
Practice address
123 Bo Bo Dr
Crystal Springs, MS 39059
Phone
(601) 892-2225
Fax
(601) 892-1456
NPI assigned
Sep 22, 2006
Organization subpart
Yes
Parent organization
COPIAH COUNTY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Kortney M. Gaddy
Title
Cfo
Phone
(601) 574-7200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MS
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

123 Bo Bo Dr
Crystal Springs, MS 39059

Mailing address

27190 Hwy 28
Hazlehurst, MS 39083
Phone (601) 574-7000

Other identifiers 8

IdentifierTypeStateIssuer
00012939MedicaidMS
00011981MedicaidMS
00015329MedicaidMS
00113908MedicaidMS
00119484MedicaidMS
00122024MedicaidMS
00116996MedicaidMS
09014049MedicaidMS

Other names 1

  • Crystal Springs 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
O20080714000378 MS Part B Supplier - Clinic/Group Practice 3577569862 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Crystal Springs, MS; Hazlehurst, MS
O20240417000448 MS Part A Provider - Rural Health Clinic 2062583487 Practice locations: Crystal Springs, MS

Rural health clinic certification: CCN 258675

Legal name
COPIAH COUNTY MEDICAL CENTER
Doing business as
CRYSTAL SPRINGS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 6, 2023
Last certification
Dec 6, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Sep 1, 1950 in MS
Enrollment address
123 Bo Bo Dr
Crystal Springs, MS 39059-2741
Related CCNs
251327

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

Other NPIs with the same Medicare PAC ID 3

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.

National Provider Directory

National Provider Directory
Tax ID family
Copiah Medical Associates2 organizations share this tax ID, including this one
Part of
Copiah County Medical Center

Other organizations with this tax ID 1

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

Locations

223 Magnolia St
Hazlehurst, MS 39083
Phone (601) 894-4541

1096 Beech St
Wesson, MS 39191
Phone (601) 643-2432

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Copiah County Medical Center Organization, Hazlehurst, MS Other May 1, 2022
Kortney Gaddy Individual W-2 Managing EmployeeCfo May 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 2

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

FacilityTypeRoleSince
Copiah County Medical CenterHazlehurst, MS, CCN 251327 Hospital Operational/Managerial Control (100%) Jan 1, 2006
Copiah County Medical CenterHazlehurst, MS, CCN 25Z327 Hospital Operational/Managerial Control (100%) Jan 1, 2006

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 95

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

View all 95

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1972603819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27190 HWY 28",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "39083",
            "telephone_number": "601-574-7000",
            "fax_number": "601-892-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 BO BO DR",
            "city": "CRYSTAL SPRINGS",
            "state": "MS",
            "postal_code": "39059",
            "telephone_number": "601-892-2225",
            "fax_number": "601-892-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPIAH COUNTY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COPIAH COUNTY MEDICAL CENTER",
        "enumeration_date": "2006-09-22",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "GADDY",
        "authorized_official_first_name": "KORTNEY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-574-7200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00012939",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00011981",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00015329",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00113908",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119484",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122024",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00116996",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014049",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Springs Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal Springs, MS

Sources for this page

Verify at the official NPI Registry.