NPIMap

Organization Active NPI

Womens Pavilion of South Mississippi, PLLC

  • Obstetrics & Gynecology Physician
  • Columbia, MS
National Provider Identifier
1306922653
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
WOMENS PAVILION OF SOUTH MISSISSIPPI, PLLC
Practice address
551 Eagle Day Ave
Columbia, MS 39429-3605
Phone
(601) 736-6137
Fax
(601) 731-1383
NPI assigned
Oct 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Authorized official

Name
Ms. Holley Johnson, MHA
Title
Administrator
Phone
(601) 450-9425

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

551 Eagle Day Ave
Columbia, MS 39429-3605

Mailing address

6524 U S Highway 98
Hattiesburg, MS 39402-8569
Phone (601) 268-9393

Other identifiers 1

IdentifierTypeStateIssuer
09014107MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726001079 MS Part B Supplier - Clinic/Group Practice 5799769535 Receives reassigned benefits from 14 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ellisville, MS; Hattiesburg, MS

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1306922653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6524 U S HIGHWAY 98",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028569",
            "telephone_number": "601-268-9393",
            "fax_number": "601-268-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 EAGLE DAY AVE",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293605",
            "telephone_number": "601-736-6137",
            "fax_number": "601-731-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOMENS PAVILION OF SOUTH MISSISSIPPI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-30",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "HOLLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-450-9425",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014107",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; 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.