NPIMap

Organization Active NPI

North Mississippi Faculty Practice Plan LLC

Doing business as Family Medicine Residency Center

  • Family Medicine Physician
  • Tupelo, MS
National Provider Identifier
1255692356
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTH MISSISSIPPI FACULTY PRACTICE PLAN LLC
Doing business as
Family Medicine Residency Center
Practice address
1665 S Green St
Tupelo, MS 38804-6556
Phone
(662) 377-2189
Fax
(662) 377-2263
NPI assigned
Jun 5, 2012
Last updated
Jan 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH MISSISSIPPI FACULTY PRACTICE PLAN LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 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
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1665 S Green St
Tupelo, MS 38804-6556

Mailing address

808 Varsity Dr
Tupelo, MS 38801-4613
Phone (662) 377-2189

Other identifiers 1

IdentifierTypeStateIssuer
003684837MedicaidMS

Other names 1

  • Family Medicine Residency Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120807000540 MS Part B Supplier - Clinic/Group Practice 2961658950 Receives reassigned benefits from 11 practitioners
Practice locations: Tupelo, MS

National Provider Directory

National Provider Directory
Tax ID family
North Mississippi Faculty Practice2 organizations share this tax ID, including this one
Part of
North Mississippi Faculty Practice

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1338854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1255692356",
    "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": "662-377-2189",
            "fax_number": "662-377-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 S GREEN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388046556",
            "telephone_number": "662-377-2189",
            "fax_number": "662-377-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MISSISSIPPI FACULTY PRACTICE PLAN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH MISSISSIPPI FACULTY PRACTICE PLAN LLC",
        "enumeration_date": "2012-06-05",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003684837",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Residency Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medicine Residency Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.