NPIMap

Organization Active NPI

Vicksburg Healthcare LLC

Doing business as River Region Health System

  • Anesthesiology Physician
  • Vicksburg, MS
National Provider Identifier
1629084058
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
VICKSBURG HEALTHCARE LLC
Doing business as
River Region Health System
Practice address
2100 Highway 61 N
Vicksburg, MS 39183-8211
Phone
(601) 883-5695
NPI assigned
Jul 31, 2006
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
VICKSBURG HEALTHCARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Kristy Music
Title
Director Provider Enrollment
Phone
(615) 465-7000

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X
Anesthesiologist Assistant 367H00000X
Anesthesiology Physician 207L00000X Primary
Emergency Medicine Physician 207P00000X
Cytopathology Physician 207ZC0500X
Anatomic Pathology Physician 207ZP0101X
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X

Addresses

Primary practice location

2100 Highway 61 N
Vicksburg, MS 39183-8211

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-3000

Other practice location 1

161 River Oaks Dr
Canton, MS 39046-5375
Phone (601) 326-8206

Other practice location 2

350 Crossgates Blvd
Brandon, MS 39042-2601
Phone (601) 326-8206

Other practice location 3

1850 Chadwick Dr
Jackson, MS 39204-3404
Phone (601) 326-8206

Other practice location 4

1030 River Oaks Dr
Flowood, MS 39232-9553
Phone (601) 932-1030

Other identifiers 6

IdentifierTypeStateIssuer
000583271MedicaidMS
200009033MedicaidMS
200008380MedicaidMS
1444600MedicaidLA
200010284MedicaidMS
200008980MedicaidMS

Other names 1

  • River Region Health System Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040213000299 MS Part B Supplier - Clinic/Group Practice 4688575129 Receives reassigned benefits from 65 practitioners
Practice locations: Brandon, MS; Vicksburg, MS; Jackson, MS; Flowood, MS; Canton, MS

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
River Region ER Physici5 organizations share this tax ID, including this one
Part of
River Region ER Physici

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 McAuley Dr
Vicksburg, MS 39183
Phone (601) 631-2131

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Merit Health River RegionVicksburg, MS, CCN 25S031 Hospital 5% Or Greater Direct Ownership Interest Jul 25, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 92

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 92

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1629084058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-3000",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838211",
            "telephone_number": "601-883-5695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "161 River Oaks Dr",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MS",
            "postal_code": "390465375",
            "country_code": "US",
            "telephone_number": "601-326-8206",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 Crossgates Blvd",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "MS",
            "postal_code": "390422601",
            "country_code": "US",
            "telephone_number": "601-326-8206",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1850 Chadwick Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392043404",
            "country_code": "US",
            "telephone_number": "601-326-8206",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1030 River Oaks Dr",
            "address_purpose": "LOCATION",
            "city": "Flowood",
            "state": "MS",
            "postal_code": "392329553",
            "country_code": "US",
            "telephone_number": "601-932-1030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VICKSBURG HEALTHCARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VICKSBURG HEALTHCARE LLC",
        "enumeration_date": "2006-07-31",
        "last_updated": "2025-09-02",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "MUSIC",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7000"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000583271",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200009033",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200008380",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1444600",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200010284",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200008980",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Region Health System",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vicksburg, MS

Sources for this page

Verify at the official NPI Registry.