NPIMap

Organization Active NPI

Ms State Department of Health

  • Community/Behavioral Health Agency
  • Jackson, MS
National Provider Identifier
1053489260
Registry record updated Dec 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MS STATE DEPARTMENT OF HEALTH
Practice address
570 E Woodrow Wilson Ave
Jackson, MS 39216-4538
Phone
(601) 906-0879
NPI assigned
Dec 4, 2006
Last updated
Dec 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2022

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

Authorized official

Name
Miranda Hillman, RHIA, MBA-HM
Title
Office Director
Phone
(601) 906-0879

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

570 E Woodrow Wilson Ave
Jackson, MS 39216-4538

Mailing address

570 E Woodrow Wilson Ave
Jackson, MS 39216-4538
Phone (601) 906-0879

Other practice location 1

100 Tamberline St
Brandon, MS 39042-3164
Phone (601) 825-2141

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315000937 MS Part B Supplier - Clinic/Group Practice 0244129245 Receives reassigned benefits from 54 practitioners

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mississippi Department Health126 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1212 Northpark Ln NE
Brookhaven, MS 39601
Phone (601) 833-3314

801 N Lehmberg Rd
Columbus, MS 39702
Phone (662) 328-6091

225 S Market St
Holly Springs, MS 38635
Phone (662) 252-4621

350 W Woodrow Wilson Ave
Ste 411C
Jackson, MS 39213
Phone (601) 713-4091

415 Highway 61 N
Natchez, MS 39120
Phone (601) 445-4601

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669939200000",
    "number": "1053489260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164538",
            "telephone_number": "601-906-0879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164538",
            "telephone_number": "601-906-0879"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Tamberline St",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "MS",
            "postal_code": "390423164",
            "country_code": "US",
            "telephone_number": "601-825-2141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MS STATE DEPARTMENT OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "HILLMAN",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "OFFICE DIRECTOR",
        "authorized_official_telephone_number": "601-906-0879",
        "authorized_official_credential": "RHIA, MBA-HM"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.