NPIMap

Organization Active NPI

North Mississippi Medical Center

  • Obstetrics & Gynecology Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1790091304
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
Legal business name
NORTH MISSISSIPPI MEDICAL CENTER
Practice address
4566 S Eason Blvd
Tupelo, MS 38801-6540
Phone
(662) 377-4962
Fax
(662) 377-2257
NPI assigned
Aug 20, 2010
Organization subpart
Yes
Parent organization
NORTH MISSISSIPPI MEDICAL CENTERAs 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
Obstetrics & Gynecology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LX0001X Primary

Addresses

Primary practice location

4566 S Eason Blvd
Tupelo, MS 38801-6540

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
001720372MedicaidMS

Other names 1

  • OB/Gyn Nurse Practitioners Doing business as

Medicare participation

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

Enrollment records 1

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

National Provider Directory

National Provider Directory
Tax ID family
Anant Shenoy MD65 organizations share this tax ID, including this one
Part of
Anant Shenoy MD

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

1207 Highway 182 W
Ste D
Starkville, MS 39759
Phone (662) 377-7170

1041 S Madison St
Tupelo, MS 38801
Phone (601) 844-8754

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1790091304",
    "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": "4566 S EASON BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016540",
            "telephone_number": "662-377-4962",
            "fax_number": "662-377-2257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH MISSISSIPPI MEDICAL CENTER",
        "enumeration_date": "2010-08-20",
        "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": "363LX0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001720372",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OB/Gyn Nurse Practitioners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

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