COVINGTON COUNTY HOSPITAL — NPI 1003654567 (Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) in RALEIGH, MS)

CMS-1500 Box 24J / 33a • NPI

1003654567

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207PE0004X (CMS 93)

Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)

Box 32 Service Location & ZIP+4

347 MAGNOLIA DR, RALEIGH, MS, 39153-6011

✓ 9-Digit EDI 837 ZIP+4 (39153-6011)

Practice Phone & Referral Fax

(601) 640-1711

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1003654567 (COVINGTON COUNTY HOSPITAL) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1003654567` (NPI-2 Organization / Facility)
Provider / Legal Name	COVINGTON COUNTY HOSPITAL
Plain-English Specialty	Board-Certified Emergency Medicine Physician (ER / Trauma Doctor) NUCC Code: `207PE0004X` (Emergency Medicine, Emergency Medical Services)
Certifying / Licensing Body	American Board of Emergency Medicine (ABEM)
Practice Location Address	347 MAGNOLIA DR, RALEIGH, MS, 39153-6011
Practice Telephone / Fax	Tel: (601) 640-1711
Administrative Mailing Address	PO BOX 2499, COLLINS, MS, 39428-2499
Enumeration & Last Sync	Enumerated: 2024-07-18 \| CMS Record Updated: 2026-04-09
Authorized Official	ANISSA EVANS (Credentialing Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

347 MAGNOLIA DR, RALEIGH, MS, 39153-6011

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Plain-English Taxonomy & CMS Crosswalk (207PE0004X)

What Does Taxonomy Code 207PE0004X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207PE0004X translates to:
"Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 93 (Physician/Emergency Medicine)
Certifying / Accrediting Authority: American Board of Emergency Medicine (ABEM)
Clinical Scope: Immediate life-or-limb emergencies, severe chest pain, stroke symptoms, deep contaminated wounds needing tetanus prophylaxis, or severe dehydration.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (COVINGTON COUNTY HOSPITAL)

Typical CPT / Diagnostic Procedures:

Level 4 & Level 5 Emergency Department Resuscitation (CPT 99284–99285)
Point-of-Care Emergency Ultrasound (eFAST), Intubation & Central Line Placement
Acute Laceration Repair, Tetanus Prophylaxis & Fracture Splinting

Common Therapeutic Classes:

Epinephrine Auto-Injectors / IV Infusions, Atropine & Amiodarone
Tetanus Toxoid / Tdap & Tetanus Immunoglobulin (TIG)
Empiric Sepsis Antibiotics, Parenteral Ketorolac & Ondansetron

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207PE0004X` — Emergency Medicine, Emergency Medical Services Plain English: Board-Certified Emergency Medicine Physician (ER / Trauma Doctor)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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COVINGTON COUNTY HOSPITAL (NPI #1003654567)