Off Main Street Medical PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R764114 Issued in MS

Legal business name

OFF MAIN STREET MEDICAL PLLC

Practice address

336 Eureka Street
Taylorsville, MS 39168-0291

Phone

(601) 785-4322

Fax

(601) 785-6681

NPI assigned

Feb 3, 2015

Organization subpart

No

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

Authorized official

Name

Sharon L Scruggs, CFNPNPI 1164521548

Title

Owner

Phone

(601) 785-4322

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

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

• Sharon L Scruggs, FNP-BC

  • Nurse Practitioner
  • Taylorsville, MS
  • NPI 1164521548
  Medicare reassignment Care Compare group NPD Authorized official
• Mark Waylon Scruggs, FNP-C

  • Nurse Practitioner
  • Taylorsville, MS
  • NPI 1851113252
  Medicare reassignment Care Compare group NPD
• Helena Lott

  • Clinical Medical Laboratory
  • Magee, MS
  • NPI 1689563413
  NPD

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

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1023408614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 291",
            "address_2": "336 EUREKA STREET",
            "city": "TAYLORSVILLE",
            "state": "MS",
            "postal_code": "391680291",
            "telephone_number": "601-785-4322",
            "fax_number": "601-785-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 EUREKA STREET",
            "city": "TAYLORSVILLE",
            "state": "MS",
            "postal_code": "391680291",
            "telephone_number": "601-785-4322",
            "fax_number": "601-785-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OFF MAIN STREET MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-03",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A",
        "authorized_official_last_name": "SCRUGGS",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-785-4322",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R764114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vera Denise Kennedy-Miller, LMT#392 MASSAGE THEP
• Magee Benevolent Association
• Mississippi Medical Clinic
• Mississippi State Department of Health
• Stephen Grant Nichols, MPT
• Sheuna Posey, LCMHT
• Randy'S House of Medicine
• Randys House of Medicine
• Carolyn Ann Schrader, N.P.
• Hailey Scott, PT, DPT

• Family Nurse Practitioner in Taylorsville, MS
• Providers in Taylorsville, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.