NPIMap

Organization Active NPI

Clay County Medical Corporation

Doing business as North Mississippi Urology

  • Urology Physician
  • Starkville, MS
National Provider Identifier
1124649678
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
CLAY COUNTY MEDICAL CORPORATION
Doing business as
North Mississippi Urology
Practice address
100 Wilburn Way Ste a
Starkville, MS 39759-3692
Phone
(662) 498-1400
Fax
(662) 498-1407
NPI assigned
May 6, 2020
Last updated
Jan 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Authorized official

Name
Bruce Toppin
Title
Corporate Secretary
Phone
(662) 377-4229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

100 Wilburn Way Ste a
Starkville, MS 39759-3692

Mailing address

808 Varsity Dr
Tupelo, MS 38801-4613
Phone (662) 377-3204

Other identifiers 2

IdentifierTypeStateIssuer
009452018MedicaidMS
355782OtherMSMEDICARE

Other names 1

  • North Mississippi Urology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041119000718 MS Part B Supplier - Clinic/Group Practice 4789649609 Receives reassigned benefits from 98 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Point, MS; Starkville, MS; Eupora, MS; Aberdeen, MS

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Clay Cty Med Corp18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

100 Wilburn Way
Ste A
Starkville, MS 39759
Phone (662) 498-1400

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1588723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1124649678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 VARSITY DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014613",
            "telephone_number": "662-377-3204",
            "fax_number": "662-377-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WILBURN WAY STE A",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "397593692",
            "telephone_number": "662-498-1400",
            "fax_number": "662-498-1407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAY COUNTY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-06",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "TOPPIN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "662-377-4229"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009452018",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "355782",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Mississippi Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Starkville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; 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.