NPIMap

Organization Active NPI

State of Mississippi - University of Mississippi Medical Center

  • Clinic/Center
  • Jackson, MS
National Provider Identifier
1245818301
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 815-2005
NPI assigned
Mar 31, 2021
Last updated
Sep 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Jeffrey Grimsley
Title
Cfo
Phone
(601) 815-8732

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

504 Clinton Center Dr
Cbo-Suite 4300
Clinton, MS 39056-5677
Phone (601) 815-2005

Other names 1

  • UMMC - MDPP Other name

Electronic endpoints 2

TypeEndpointUseAffiliation
Other URL providerenrollment@umc.edu
Other URL providerenrollment@umc.edu

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200409002418 MS MDPP Supplier - in-Person MDPP Supplier 1850293036 1 other NPI on this enrollment
Practice locations: Jackson, MS

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 1

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

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 20

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

View all 20

Locations

777 Lakeland Dr
#103
Jackson, MS 39216

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

NPI Registry JSON

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

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1245818301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 CLINTON CENTER DR",
            "address_2": "CBO-SUITE 4300",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565677",
            "telephone_number": "601-815-2005",
            "fax_number": "601-815-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-31",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "GRIMSLEY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-815-8732"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "providerenrollment@umc.edu",
            "affiliation": "N",
            "address_1": "2500 N State St",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "providerenrollment@umc.edu",
            "affiliation": "N",
            "address_1": "2500 N State St",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "UMMC - MDPP",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "UMMC - MDPP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.