NPIMap

Organization Active NPI

Behavioral Medicine Clinic,PA

  • Prescribing (Medical) Psychologist
  • Meridian, MS
National Provider Identifier
1588846281
Registry record updated Jun 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
License
14095 Issued in MS
Legal business name
BEHAVIORAL MEDICINE CLINIC,PA
Practice address
5000 Hwy 39 N
Meridian, MS 39301-1021
Phone
(601) 482-2400
NPI assigned
Dec 4, 2007
Last updated
Jun 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2010

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

Authorized official

Name
Dr. Terry Jordan, M.M.NPI 1417046327
Title
Owner
Phone
(601) 482-2400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) Psychologist 103TP0016X 14095 MS Primary

Addresses

Primary practice location

5000 Hwy 39 N
Meridian, MS 39301-1021

Mailing address

5000 Hwy 39 N
Meridian, MS 39301-1021
Phone (601) 482-2400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080805000086 MS Part B Supplier - Clinic/Group Practice 5092889360 Receives reassigned benefits from 12 practitioners
Practice locations: Meridian, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275350400000",
    "number": "1588846281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 HWY 39 N",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393011021",
            "telephone_number": "601-482-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HWY 39 N",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393011021",
            "telephone_number": "601-482-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL MEDICINE CLINIC,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2010-06-01",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-482-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.M."
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "MS",
            "license": "14095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2010; 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.