Individual provider Active NPI

Jessica Bass

  • Psychiatric/Mental Health Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1558080739
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
887149 Issued in MS
Practice address
2117 Broadway Drive
Hattiesburg, MS 39402-3210
Phone
(601) 288-8050
Fax
(601) 288-8058
NPI assigned
Aug 23, 2022
Last updated
Feb 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 887149 MS Primary
Critical Care Medicine Registered Nurse 163WC0200X 821402 MS

Addresses

Primary practice location

2117 Broadway Drive
Hattiesburg, MS 39402-3210

Mailing address

2117 Broadway Drive
Hattiesburg, MS 39402-3210
Phone (601) 288-8050

Other practice location 1

1 Lincoln Pkwy
Hattiesburg, MS 39402-3262
Phone (601) 288-8050

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL other Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240626001195 MS Practitioner - Nurse Practitioner 2769926229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forrest County General HospitalGroup PAC ID 1052397767, 107 clinicians

Practice addresses (Care Compare)

2117 Broadway Dr
Hattiesburg, MS 39402-3210
Phone (601) 288-8050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
821402MSMDCritical Care Medicine Registered Nurse
887149MSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince May 11, 2024 Accepting new patients
Forrest County General Hospital CurrentSince May 11, 2024 Accepting new patients
Forrest County General Hospital Current Accepting new patients

Locations

2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1558080739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DRIVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DRIVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Lincoln Pkwy",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394023262",
            "country_code": "US",
            "telephone_number": "601-288-8050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASS",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2025-02-24",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MS",
            "license": "887149",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "MS",
            "license": "821402",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "other",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "other",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "344 Baker Rd",
            "city": "Purvis",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394753906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.