NPIMap

Organization Active NPI

North Mississippi Medical Center Inc.

Doing business as Children's Clinic

  • Rural Health Clinic/Center
  • Tupelo, MS
National Provider Identifier
1649727447
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTH MISSISSIPPI MEDICAL CENTER INC.
Doing business as
Children's Clinic
Practice address
199 Grandstand Place
Tupelo, MS 38804
Phone
(662) 377-7337
Fax
(662) 842-1350
NPI assigned
Sep 9, 2016
Last updated
Jan 22, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH MISSISSIPPI HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Bruce Toppin
Title
Corporate Secretary
Phone
(662) 377-4229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

199 Grandstand Place
Tupelo, MS 38804

Mailing address

808 Varsity Dr
Tupelo, MS 38801-4613
Phone (662) 377-2386

Other identifiers 1

IdentifierTypeStateIssuer
007607718MedicaidMS

Other names 1

  • Children's Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040413000541 MS Part B Supplier - Clinic/Group Practice 9931010600 Receives reassigned benefits from 570 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Tupelo, MS; West Point, MS; Starkville, MS; Corinth, MS; Oxford, MS
O20171220002714 MS Part A Provider - Rural Health Clinic 9931010600 Practice locations: Tupelo, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649727447. Details of each certification follow.

Rural health clinic certification: CCN 258551

Legal name
NORTH MISSISSIPPI MEDICAL CENTER, INC.
Doing business as
CHILDRENS CLINIC - TUPELO
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 11, 2018
Last certification
Sep 11, 2018
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Apr 2, 1982 in DE
Enrollment address
1573 Medical Park Cir
Tupelo, MS 38801-6580
Related CCNs
250004

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0316911North Mississippi Med Ctr Dba Children's Clinic199 Grandstand Place, Tupelo, MS 38804ComplianceDec 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Paulo Gonzalez DO65 organizations share this tax ID, including this one
Part of
North Mississippi Health Services Inc

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

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Calude Waycaster Individual Corporate DirectorBoard Member Oct 1, 2017
William H Milam Individual Corporate DirectorChairman of the Board Oct 1, 2017
Mark H Craig Individual Corporate DirectorBoard Member Oct 1, 2017
Mark a Ray Individual Corporate DirectorBoard Member Oct 1, 2017
Bruce J Toppin Individual Corporate OfficerSecretary Oct 1, 2017
Tom Foy Individual Corporate DirectorBoard Member Oct 1, 2017
Lewis Whitfield Individual Corporate DirectorBoard Member Oct 1, 2017
Sharon D Nobles Individual Corporate OfficerTreasurer Oct 1, 2017
William Holliman Individual Corporate DirectorBoard Member Oct 1, 2017
Samuel C Pace Individual Corporate DirectorBoard Member Oct 1, 2017
Michael S Spees Individual Corporate OfficerCeo Oct 1, 2017
Erskine Hooper Individual Corporate DirectorBoard Member Oct 1, 2017
John Wheeler Individual Corporate DirectorBoard Member Oct 1, 2017
Barney J Guyton Individual Corporate DirectorBoard Member Oct 1, 2017
Chris Rogers Individual Corporate DirectorBoard Member Oct 1, 2017
David Copenhaver Individual Corporate DirectorBoard Member Oct 1, 2017
David Wilson Individual Corporate OfficerPresident Oct 1, 2017
W-2 Managing EmployeeAdministrator Oct 1, 2017
North Mississippi Medical Center, Inc. Organization, Tupelo, MS Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Aug 24, 1992 100%

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Baldwyn Nursing FacilityBaldwyn, MS, CCN 255161 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Mar 16, 2009
Mar 16, 2009
Mar 16, 2009

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1473379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1649727447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 VARSITY DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014613",
            "telephone_number": "662-377-2386",
            "fax_number": "662-377-2057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 GRANDSTAND PLACE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38804",
            "telephone_number": "662-377-7337",
            "fax_number": "662-842-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MISSISSIPPI MEDICAL CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH MISSISSIPPI HEALTH SERVICES",
        "enumeration_date": "2016-09-09",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "TOPPIN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "662-377-4229"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007607718",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Children's Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.