NPIMap

Organization Active NPI

Northwest Miss Regional Medical Center

Doing business as Northwest Mississippi Regional Medical Center

  • Emergency Medicine Physician
  • Clarksdale, MS
National Provider Identifier
1699468686
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
NORTHWEST MISS REGIONAL MEDICAL CENTER
Doing business as
Northwest Mississippi Regional Medical Center
Practice address
1970 Hospital Dr
Clarksdale, MS 38614-7202
Phone
(662) 627-3211
Fax
(662) 624-3214
NPI assigned
May 26, 2023
Last updated
May 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Authorized official

Name
Lorie Till
Title
Ceo
Phone
(662) 624-3463

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

1970 Hospital Dr
Clarksdale, MS 38614-7202

Mailing address

PO Box 1218
Clarksdale, MS 38614-1218
Phone (662) 627-3211

Other names 1

  • Northwest Mississippi Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240610002576 MS Part B Supplier - Clinic/Group Practice 3173969177 Receives reassigned benefits from 28 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksdale, MS; Cleveland, MS

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2000 N State St
Ste B
Clarksdale, MS 38614
Phone (662) 624-3463

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1685059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1699468686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1218",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386141218",
            "telephone_number": "662-627-3211",
            "fax_number": "662-624-3214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 HOSPITAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386147202",
            "telephone_number": "662-627-3211",
            "fax_number": "662-624-3214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MISS REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-26",
        "last_updated": "2024-05-22",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "TILL",
        "authorized_official_first_name": "LORIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-624-3463"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Mississippi Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.