NPIMap

Organization Active NPI

Urgent Care Clinic of Oxford

  • Family Medicine Physician
  • Oxford, MS
National Provider Identifier
1043421357
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
13516 Issued in MS
Legal business name
URGENT CARE CLINIC OF OXFORD
Practice address
1487 Belk Blvd
Oxford, MS 38655-5371
Phone
(662) 234-1090
Fax
(662) 234-0432
NPI assigned
May 25, 2007
Last updated
Mar 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

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

Authorized official

Name
Mrs. Kelley Denise McCullough
Title
Office Manager
Phone
(662) 234-1090

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R728594 MS
Family Medicine Physician 207Q00000X 18438 MS
Family Medicine Physician 207Q00000X 10602 MS
Family Medicine Physician 207Q00000X 13516 MS Primary

Addresses

Primary practice location

1487 Belk Blvd
Oxford, MS 38655-5371

Mailing address

1487 Belk Blvd
Oxford, MS 38655-5371
Phone (662) 234-1090

Other identifiers 3

IdentifierTypeStateIssuer
06759064MedicaidMS
0015608MedicaidMS
9014432MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110221000323 MS Part B Supplier - Clinic/Group Practice 9537109491 Receives reassigned benefits from 9 practitioners
Practice locations: Oxford, MS

National Provider Directory

National Provider Directory

Locations

1487 Belk Blvd
Oxford, MS 38655
Phone (601) 234-1090

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IABFAA

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1043421357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1487 BELK BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555371",
            "telephone_number": "662-234-1090",
            "fax_number": "662-234-0432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1487 BELK BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555371",
            "telephone_number": "662-234-1090",
            "fax_number": "662-234-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URGENT CARE CLINIC OF OXFORD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-234-1090",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R728594",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "18438",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "10602",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "13516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06759064",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015608",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9014432",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oxford, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.