NPIMap

Organization Active NPI

Magee Benevolent Association

Doing business as the medical pavilion

  • Family Nurse Practitioner
  • Raleigh, MS
National Provider Identifier
1225157258
Registry record updated Mar 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R764114 Issued in MS
Legal business name
MAGEE BENEVOLENT ASSOCIATION
Doing business as
the medical pavilion
Practice address
234 Magnolia Dr
Raleigh, MS 39153-6016
Phone
(601) 782-9797
Fax
(601) 782-9790
NPI assigned
Mar 29, 2007
Last updated
Mar 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2011

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

Authorized official

Name
Ms. Sharon L Scruggs, FNP
Title
Family Nurse Practioner
Phone
(601) 782-9797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R764114 MS Primary

Addresses

Primary practice location

234 Magnolia Dr
Raleigh, MS 39153-6016

Mailing address

234 Magnolia Dr
Raleigh, MS 39153-6016
Phone (601) 782-9797

Other identifiers 2

IdentifierTypeStateIssuer
00117436MedicaidMS
07585555MedicaidMS

Other names 1

  • the medical pavilion Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000400 MS Part B Supplier - Clinic/Group Practice 3678466463 Receives reassigned benefits from 87 practitioners
10 other NPIs on this enrollment
Practice locations: Magee, MS; Mize, MS; Raleigh, MS; Taylorsville, MS

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Magee General Hospital9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Magee General Hospital - Swing BedMagee, MS, CCN 25U124 Hospital 5% Or Greater Direct Ownership Interest Oct 31, 2007

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 89

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.

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301443200000",
    "number": "1225157258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 MAGNOLIA DR",
            "city": "RALEIGH",
            "state": "MS",
            "postal_code": "391536016",
            "telephone_number": "601-782-9797",
            "fax_number": "601-782-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 MAGNOLIA DR",
            "city": "RALEIGH",
            "state": "MS",
            "postal_code": "391536016",
            "telephone_number": "601-782-9797",
            "fax_number": "601-782-9790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGEE BENEVOLENT ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2011-03-30",
        "status": "A",
        "authorized_official_last_name": "SCRUGGS",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTIONER",
        "authorized_official_telephone_number": "601-782-9797",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R764114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117436",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07585555",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "the medical pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raleigh, MS

Sources for this page

Verify at the official NPI Registry.