Individual provider Active NPI

Christi W Sims, P.T.

  • Physical Therapist
  • Kosciusko, MS
National Provider Identifier
1114956620
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT1718 Issued in MS
Practice address
130 Parkway PLZ
Kosciusko, MS 39090-3217
Phone
(662) 289-3588
Fax
(662) 289-3533
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT1718 MS Primary

Addresses

Primary practice location

130 Parkway PLZ
Kosciusko, MS 39090-3217

Mailing address

PO Box 23996
Jackson, MS 39225-3996
Phone (601) 206-6100

Other practice location 1

140 N Wells St
Kosciusko, MS 39090-3637
Phone (662) 290-6020

Other identifiers 1

IdentifierTypeStateIssuer
03079372MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040713001044 MS Practitioner - Physical Therapist in Private Practice 6709864903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

130 Pkwy PLZ
Kosciusko, MS 39090-3217
Phone (662) 289-3588

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT1718MSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Group of Mississippi LLC CurrentSince Feb 28, 2017 Accepting new patients
Pro Health Aquisition Company Physical Therapist Past Accepting new patients
Premier Medical Group of Mississippi LLC PastSince Feb 28, 2017 Accepting new patients

Locations

130 Parkway Plz
Kosciusko, MS 39090
Phone (662) 289-3588

332 Highway 12 W
Kosciusko, MS 39090
Phone (601) 206-6100

340 Highway 12 W
Kosciusko, MS 39090
Phone (662) 289-1551

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1114956620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23996",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253996",
            "telephone_number": "601-206-6100",
            "fax_number": "601-206-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PARKWAY PLZ",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903217",
            "telephone_number": "662-289-3588",
            "fax_number": "662-289-3533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 N Wells St",
            "address_purpose": "LOCATION",
            "city": "Kosciusko",
            "state": "MS",
            "postal_code": "390903637",
            "country_code": "US",
            "telephone_number": "662-290-6020",
            "fax_number": "662-290-6070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMS",
        "first_name": "CHRISTI",
        "middle_name": "W",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT1718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03079372",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kosciusko, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.