NPIMap

Organization Active NPI

State of Mississippi - University of Mississippi Medical Center

  • Rehabilitation Clinic/Center
  • Jackson, MS
National Provider Identifier
1619778586
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Practice address
350 W Woodrow Wilson Ave Ste 600
Jackson, MS 39213-7627
Phone
(601) 815-6700
NPI assigned
Mar 24, 2025
Last updated
Jul 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Authorized official

Name
Jeffrey Grimsley
Title
Associate Cfo - Clinical Operations
Phone
(601) 815-6270

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

350 W Woodrow Wilson Ave Ste 600
Jackson, MS 39213-7627

Mailing address

PO Box 11407
Birmingham, AL 35246-2130
Phone (601) 815-6064

Other practice location 1

764 Lakeland Dr Fl 4
Jackson, MS 39216-4651
Phone (601) 815-6700

Other practice location 2

124 UMMC Way
Ridgeland, MS 39157
Phone (601) 815-6064

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090414000575 MS Part B Supplier - Clinic/Group Practice 1850293036 Receives reassigned benefits from 1,922 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Univ Med Pavillion62 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2466 Flowood Dr
Jackson, MS 39232
Phone (601) 414-6520

764 Lakeland Dr
Fl 4
Jackson, MS 39216
Phone (601) 815-6700

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1742774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1619778586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352462130",
            "telephone_number": "601-815-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE STE 600",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137627",
            "telephone_number": "601-815-6700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "764 Lakeland Dr Fl 4",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164651",
            "country_code": "US",
            "telephone_number": "601-815-6700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "124 UMMC Way",
            "address_purpose": "LOCATION",
            "city": "Ridgeland",
            "state": "MS",
            "postal_code": "39157",
            "country_code": "US",
            "telephone_number": "601-815-6064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "GRIMSLEY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "ASSOCIATE CFO - CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "601-815-6270"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.