Active NPI
Ridgeland Medical Clinic
- Family Medicine Physician
- Ridgeland, MS
National Provider Identifier
1053917849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- RIDGELAND MEDICAL CLINIC
- Practice address
- 587 Highway 51 Ste T
Ridgeland, MS 39157-2567 - Phone
- (601) 790-7711
- Fax
- (601) 790-7712
- NPI assigned
- Dec 8, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Erica Berry
- Title
- Admin
- Phone
- (601) 790-7711
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
587 Highway 51 Ste T
Ridgeland, MS 39157-2567
Mailing address
587 Highway 51 Ste T
Ridgeland, MS 39157-2567
Phone (601) 790-7711
Other practice location 1
396 Business Park Dr Ste C
Gluckstadt, MS 39110-9482
Phone (601) 790-7711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS, GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210217000175 | MS | Part B Supplier - Clinic/Group Practice | 9032524400 |
Receives reassigned benefits from 15 practitioners Practice locations: Hattiesburg, MS; Ridgeland, MS; Tupelo, MS |
| O20220203001028 | GA | Part B Supplier - Clinic/Group Practice | 9032524400 |
Receives reassigned benefits from 1 practitioner Practice locations: Cumming, GA; Kennesaw, GA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 16
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1776902400000",
"number": "1053917849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "587 HIGHWAY 51 STE T",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391572567",
"telephone_number": "601-790-7711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "587 HIGHWAY 51 STE T",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391572567",
"telephone_number": "601-790-7711",
"fax_number": "601-790-7712"
}
],
"practiceLocations": [
{
"address_1": "396 Business Park Dr Ste C",
"address_purpose": "LOCATION",
"city": "Gluckstadt",
"state": "MS",
"postal_code": "391109482",
"country_code": "US",
"telephone_number": "601-790-7711",
"fax_number": "601-790-7712",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "RIDGELAND MEDICAL CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2020-12-08",
"last_updated": "2026-04-23",
"certification_date": "2026-04-23",
"status": "A",
"authorized_official_last_name": "BERRY",
"authorized_official_first_name": "ERICA",
"authorized_official_title_or_position": "ADMIN",
"authorized_official_telephone_number": "601-790-7711"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgeland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; 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.