State of Mississippi- University of Mississippi Medical Center
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Jackson, MS
NPI 1194930693 · NPPES record last updated Oct 2, 2007
Key facts
- NPI
- 1194930693
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- STATE OF MISSISSIPPI- UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
- 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
- Organization subpart
- No
Authorized official
- Name
- William Kennedy
- Title
- Associate Administrator
- Phone
- (601) 984-4699
Owned or controlled facilities with NPI records 16
Other NPIs on the same Medicare enrollment 15
Other NPIs with the same Medicare PAC ID 22
Corporate family (same tax ID) 17
Practitioners 956
-
George Ellis Abraham III, M.D.
-
Michael Murry Adams Jr., D.O.
-
Zachary Lee Adams, CRNA
-
Adria Nicole Adcock, CPNP-AC
-
Gerald Todd Adcock, CRNA
-
Sabahat Afshan, M.D.
-
Emem Jessica Edet Aitken, M.D.
-
Maher M. Ajour, MD
-
Svenja J. Albrecht, M.D.
-
Ashley Smith Allen, NP-C
-
Eric McWilliams Allen, CRNA
-
Kristen Alston, PH.D.
-
Priyanka Ameta, MD
-
Patricia Garcia Amolenda, M.D.
-
Yanis Amrani, MD
-
Mark Anderson, MD
-
Ashley Hopkins Anthony, FNP-C
Affiliated clinicians 9
-
Ronequa Evans, NP-C
-
Maria Clarissa Ong Tio, M.D.
-
Sheeraz Gul Abro, MD
-
Sanjana Kapoor, M.B.B.S
-
Yoshitsugu Obi, MD, PHD
Medicare Care Compare: Dialysis facility
- Listed as
- Medical Mall Dialysis
- Overall star rating
- ★☆☆☆☆ 1.0 of 5
- Ownership
- Non-profit
- Certified
- Jul 17, 2003
- Medicare certification status
- Active
- Chain
- State Owned
- Dialysis stations
- 48
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
All facility ownership & control disclosures 15
| Facility | Type | Role | Since |
|---|---|---|---|
| State of Mississippi-University of Mississippi Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jul 1, 2007 Jul 1, 2007 |
| University of Mississi Medical Center- Holmes County |
Hospital | 5% Or Greater Direct Ownership Interest | Jan 1, 2004 |
| Holmes County Hospital & Clinics |
Hospital | 5% Or Greater Direct Ownership Interest | Oct 1, 2004 |
| Ummc- Grenada |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Feb 21, 2014 Feb 21, 2014 |
| Ummc Madison |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2025 |
| Ummc Madison |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2025 |
| Lexington Rural Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | May 23, 2013 |
| West Rural Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | May 22, 2013 |
| Ummc- Grenada Women'S Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jan 1, 2014 |
| Holmes County Family Medicine Clinic- Vaiden |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Oct 1, 2016 |
| Ummc Grenada Specialty Pediatrics |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jan 1, 2014 |
| Children'S of Mississippi Greenwood Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Oct 1, 2023 |
| Ummc Greenwood Primary Care Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Oct 1, 2023 |
| Ummc Greenwood Women'S Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Oct 1, 2023 |
| Ummc Grenada Primary Medicine Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Oct 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Sigurds O Krolls MD
Locations
350 W Woodrow Wilson Ave
Ste 479
Jackson, MS 39213
Phone (601) 815-6350
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20256 | Medicaid | MS |
Other names
- UMC Medical Mall
Other providers in Jackson, MS
- State of Mississippi - University of Mississippi Medical Center
- State of Mississippi - University of Mississippi Medical Center
- State of Mississippi - University of Mississippi Medical Center
- State of Mississippi - University of Mississippi Medical Center
- State of Mississippi University of Mississippi Medical Center
- State of Mississippi- University of Mississippi Medical Center
- State of Mississippi- University of Mississippi Medical Center
- State of Mississippi-University of Mississippi Medical Center
- State of Mississippi-University of Mississippi Medical Center
- State of Mississippi-University of Mississippi Medical Center
All providers in Jackson, MS · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.