NPIMap

Organization Active NPI

State of Mississippi- University of Mississippi Medical Center

Doing business as UMC Medical Mall

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Jackson, MS
National Provider Identifier
1194930693
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
STATE OF MISSISSIPPI- UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Doing business as
UMC Medical Mall
Practice address
350 W Woodrow Wilson Ave
Suite 479
Jackson, MS 39213-7681
Phone
(601) 815-6350
Fax
(601) 815-6348
NPI assigned
May 10, 2007
Last updated
Oct 2, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Authorized official

Name
William Kennedy
Title
Associate Administrator
Phone
(601) 984-4699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

350 W Woodrow Wilson Ave
Suite 479
Jackson, MS 39213-7681

Mailing address

350 W Woodrow Wilson Ave
Suite 479
Jackson, MS 39213-7681
Phone (601) 815-6350

Other names 1

  • UMC Medical Mall Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071211000235 MS Part A Provider - End-Stage Renal Disease Facility (ESRD) 1850293036 Practice locations: Jackson, MS
O20090414000575 MS Part B Supplier - Clinic/Group Practice 1850293036 Receives reassigned benefits from 1,922 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 15

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

View all 15

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Medical Mall DialysisCCN 253503
Overall star rating
1.0 of 5
Ownership
Non-profit
Certified
Jul 17, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Chain
State Owned
Dialysis stations
48

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Sigurds O Krolls MD62 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

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

View all 17

Locations

350 W Woodrow Wilson Ave
Ste 479
Jackson, MS 39213
Phone (601) 815-6350

Ownership & related parties

All facility ownership & control disclosures 15

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
State of Mississippi-University of Mississippi Medical CenterJackson, MS, CCN 250001 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2007
Jul 1, 2007
University of Mississi Medical Center- Holmes CountyLexington, MS, CCN 25Z319 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2004
Holmes County Hospital & ClinicsLexington, MS, CCN 251319 Hospital 5% Or Greater Direct Ownership Interest Oct 1, 2004
Ummc- GrenadaGrenada, MS, CCN 250168 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 21, 2014
Feb 21, 2014
Ummc MadisonCanton, MS, CCN 250038 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Ummc MadisonCanton, MS, CCN 25U038 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2025
Lexington Rural Health ClinicLexington, MS, CCN 253813 Rural health clinic 5% Or Greater Direct Ownership Interest May 23, 2013
West Rural Health ClinicWest, MS, CCN 253812 Rural health clinic 5% Or Greater Direct Ownership Interest May 22, 2013
Ummc- Grenada Women's ServicesGrenada, MS, CCN 258626 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Holmes County Family Medicine Clinic- VaidenVaiden, MS, CCN 258625 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2016
Ummc Grenada Specialty PediatricsGrenada, MS, CCN 258627 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Children's of Mississippi Greenwood ClinicGreenwood, MS, CCN 258682 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Primary Care ClinicGreenwood, MS, CCN 258679 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Greenwood Women's ClinicGreenwood, MS, CCN 258680 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023
Ummc Grenada Primary Medicine ClinicGrenada, MS, CCN 258681 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023

Owned or controlled facilities with NPI records 16

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 16

Practitioners & affiliated clinicians

Affiliated clinicians 9

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1194930693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE",
            "address_2": "SUITE 479",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137681",
            "telephone_number": "601-815-6350",
            "fax_number": "601-815-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE",
            "address_2": "SUITE 479",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137681",
            "telephone_number": "601-815-6350",
            "fax_number": "601-815-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSISSIPPI- UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "ASSOCIATE ADMINISTRATOR",
        "authorized_official_telephone_number": "601-984-4699"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UMC Medical Mall",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.