NPIMap

Organization Active NPI

HMG Group LLC

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1255738035
Registry record updated Nov 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
07980 Issued in MS
Legal business name
HMG GROUP LLC
Practice address
4436 N State St
Suite A1
Jackson, MS 39206-5334
Phone
(601) 383-2036
Fax
(601) 981-5819
NPI assigned
Nov 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2014

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

Authorized official

Name
Johnathan Chad Gibson
Title
Office Manager
Phone
(601) 951-9197

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 07980 MS Primary
Adult Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LA2200X R860365 MS
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X R878138 MS
Women's Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LW0102X R860365 MS

Addresses

Primary practice location

4436 N State St
Suite A1
Jackson, MS 39206-5334

Mailing address

4436 N State St
Suite A1
Jackson, MS 39206-5334
Phone (601) 383-2036

Other identifiers 3

IdentifierTypeStateIssuer
04136595MedicaidMS
03727355MedicaidMS
04457077MedicaidMS

Other names 1

  • Fondren Care Clinic Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1416614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416614400000",
    "number": "1255738035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4436 N STATE ST",
            "address_2": "SUITE A1",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065334",
            "telephone_number": "601-383-2036",
            "fax_number": "601-981-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4436 N STATE ST",
            "address_2": "SUITE A1",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392065334",
            "telephone_number": "601-383-2036",
            "fax_number": "601-981-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HMG GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-22",
        "last_updated": "2014-11-22",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_middle_name": "CHAD",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "601-951-9197"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "07980",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MS",
            "license": "R860365",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R878138",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MS",
            "license": "R860365",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04136595",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03727355",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04457077",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fondren Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.