NPIMap

Organization Active NPI

Specialty Orthopedic Group of Mississippi PLLC

  • Orthopaedic Surgery Physician
  • Tupelo, MS
National Provider Identifier
1508561978
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SPECIALTY ORTHOPEDIC GROUP OF MISSISSIPPI PLLC
Practice address
910 Mary Vance Dr
Tupelo, MS 38801-6226
Phone
(662) 767-4200
Fax
(662) 432-1613
NPI assigned
Apr 4, 2023
Organization subpart
Yes
Parent organization
SPECIALTY ORTHOPEDIC GROUP OF MISSISSIPPI PLLCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Karen Gibson
Title
Admin Asst/ Credentialing
Phone
(662) 767-4200

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Other NPIs with the same Medicare PAC ID 7

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

Practitioners 41

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

View all 41

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250505001334 MS DME Supplier - Physician - Orthopedic/Orthopedic Surgery 3577878883 Practice locations: Tupelo, MS

National Provider Directory

National Provider Directory
Part of
Specialty Orthopedic Group of Ms PLLC

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary
Clinic/Center 261Q00000X

Addresses

NPPES NPI Registry

Primary practice location

910 Mary Vance Dr
Tupelo, MS 38801-6226

Mailing address

1211 S Gloster St Ste a
Tupelo, MS 38801-6548
Phone (662) 767-4200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 20, 2025.

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1508561978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 S GLOSTER ST STE A",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016548",
            "telephone_number": "662-767-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 MARY VANCE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016226",
            "telephone_number": "662-767-4200",
            "fax_number": "662-432-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY ORTHOPEDIC GROUP OF MISSISSIPPI PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIALTY ORTHOPEDIC GROUP OF MISSISSIPPI PLLC",
        "enumeration_date": "2023-04-04",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "ADMIN ASST/ CREDENTIALING",
        "authorized_official_telephone_number": "662-767-4200"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Mar 20, 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.