NPIMap

Organization Active NPI

Tallahatchie General Hospital

  • Critical Access Hospital
  • Charleston, MS
National Provider Identifier
1992706303
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
11-211 Issued in MS
Legal business name
TALLAHATCHIE GENERAL HOSPITAL
Practice address
141 Dr. T T Lewis Circle
Charleston, MS 38921-2236
Phone
(662) 647-5535
Fax
(662) 647-3677
NPI assigned
Aug 9, 2005
Last updated
Dec 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Authorized official

Name
Barbara Crocker
Title
Billing Manager
Phone
(662) 625-7176

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 11-211 MS
Critical Access Hospital 282NC0060X 11-211 MS Primary

Addresses

Primary practice location

141 Dr. T T Lewis Circle
Charleston, MS 38921-2236

Mailing address

PO Box 230
141 Dr. TT Lewis Circle
Charleston, MS 38921-0240
Phone (662) 647-5535

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040303000646 MS Part B Supplier - Clinic/Group Practice 1052208097 Receives reassigned benefits from 25 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charleston, MS; Grenada, MS; Tutwiler, MS
O20080618000399 MS Part A Provider - Critical Access Hospital 1052208097 Practice locations: Charleston, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992706303. Details of each certification follow.

Hospital certification: CCN 25Z304

Legal name
TALLAHATCHIE GENERAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
141 Dr. T. T. Lewis Circle
Charleston, MS 38921-2236
Other Hospital Practice Location

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 5

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

National Provider Directory

National Provider Directory
Tax ID family
Tallahatchie Gen Hosp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

141 Dr TT Lewis Cir
Charleston, MS 38921
Phone (662) 625-7176

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Charles Weissinger Individual Corporate OfficerCfo Jan 23, 2024
W-2 Managing Employee Jan 23, 2024
Frank McRae Individual Corporate OfficerCoo Aug 1, 2016
Donald Blackwood Individual Corporate OfficerCeo Feb 22, 2011
W-2 Managing Employee Feb 22, 2011

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Tallahatchie General HospitalCharleston, MS, CCN 251304 Hospital 5% Or Greater Direct Ownership Interest Feb 1, 2002
Holcomb ClinicGrenada, MS, CCN 258601 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2015
Tutwiler ClinicTutwiler, MS, CCN 258620 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2016

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 4

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1992706303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230",
            "address_2": "141 DR. TT LEWIS CIRCLE",
            "city": "CHARLESTON",
            "state": "MS",
            "postal_code": "389210240",
            "telephone_number": "662-647-5535",
            "fax_number": "662-647-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 DR. T T LEWIS CIRCLE",
            "city": "CHARLESTON",
            "state": "MS",
            "postal_code": "389212236",
            "telephone_number": "662-647-5535",
            "fax_number": "662-647-3677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHATCHIE GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "662-625-7176"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MS",
            "license": "11-211",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "11-211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, MS

Sources for this page

Verify at the official NPI Registry.