Individual provider Active NPI

Jimwesley Williams

  • Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1619682895
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R01146 Issued in MS
Practice address
1225 N State St
Jackson, MS 39202-2064
Phone
(601) 759-0647
NPI assigned
Jan 23, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R01146 MS Primary

Addresses

Primary practice location

1225 N State St
Jackson, MS 39202-2064

Mailing address

1225 N State St
Jackson, MS 39202-2064

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
I20230816003739 MS Practitioner - Nurse Practitioner 3173985546 Reassigns benefits to 3 organizations

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
Bear Creek Emergency Group LLCGroup PAC ID 8820587629, 33 clinicians
United Emergency Services of MississippiGroup PAC ID 9739188046, 12 clinicians

Practice addresses (Care Compare)

2124 14TH St
Meridian, MS 39301-4040
Phone (601) 553-6000

2520 5TH St N
Columbus, MS 39705-2008
Phone (662) 244-1000

Hospital & facility affiliations

  • BMH-Golden Triangle Hospital, Columbus, MS, CCN 250100

Merit-based Incentive Payment System (MIPS)

Final score
89.9 of 100Reported as group
Quality
80.75
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R01146MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mississippi Physicians, LLP Nurse Practitioner CurrentSince Jul 2, 2023 Accepting new patients
Bear Creek Emergency Group LLC Nurse Practitioner CurrentSince Nov 1, 2025 Accepting new patients
United Emergency Services of Mississippi Nurse Practitioner CurrentSince Jan 30, 2024 Accepting new patients
Mississippi Physicians LLP Current Accepting new patients

Locations

2520 5th St N
Columbus, MS 39705
Phone (662) 224-1000

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

2124 14th St
Meridian, MS 39301
Phone (601) 483-8811

Interoperability endpoints

  • Direct secure messaging: jwilliams578646@direct.bmhcc.org

Organizations & group practices 4

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

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": "1674432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1619682895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022064",
            "telephone_number": "601-759-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JIMWESLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R01146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.