NPIMap

Organization Active NPI

Northwest Miss Regional Medical Center

  • Obstetrics & Gynecology Physician
  • Clarksdale, MS
National Provider Identifier
1780423715
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NORTHWEST MISS REGIONAL MEDICAL CENTER
Practice address
2000 N State St Ste a
Clarksdale, MS 38614-6100
Phone
(662) 627-7361
NPI assigned
May 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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) 624-3480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

2000 N State St Ste a
Clarksdale, MS 38614-6100

Mailing address

PO Box 340
Clarksdale, MS 38614-0340
Phone (662) 624-3480

Other names 1

  • NWMRMC - Woman's Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241011003627 MS Part A Provider - Rural Health Clinic 3173969177 Practice locations: Clarksdale, MS

Rural health clinic certification: CCN 258687

Legal name
NORTHWEST MISS REGIONAL MEDICAL CENTER
Doing business as
NWMRMC-WOMAN'S CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 29, 2025
Last certification
Apr 29, 2025
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
2000 N State St
Ste a
Clarksdale, MS 38614-6100
Related CCNs
250042

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

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

Locations

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Lorie Till Individual Corporate OfficerChief Executive Officer Oct 3, 2023
W-2 Managing EmployeeChief Executive Officer Oct 3, 2023
Lela Keyes Individual Corporate DirectorBoard of Trustees Member Apr 1, 2023
Donell Harrell Individual Corporate DirectorBoard of Trustees Member Apr 1, 2023
Northwest Miss Regional Medical Center Organization, Clarksdale, MS Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2024 100%
Richard Bowen Flowers Individual Corporate DirectorChair, Board of Trustees Apr 1, 2023
Alan Byrd Individual Corporate DirectorBoard of Trustees Member Apr 1, 2023
Erika Stapleton Individual Corporate OfficerChief Financial Officer Feb 1, 2024
W-2 Managing EmployeeChief Executive Officer Feb 1, 2024

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1780423715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386140340",
            "telephone_number": "662-624-3480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N STATE ST STE A",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146100",
            "telephone_number": "662-627-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MISS REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "TILL",
        "authorized_official_first_name": "LORIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-624-3480"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NWMRMC - Woman's Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksdale, MS

Sources for this page

Verify at the official NPI Registry.