NPIMap

Organization Active NPI

Mississippi Methodist Hospital & Rehabilitation Center, Inc.

Doing business as Methodist Rehab Center

  • Physical Medicine & Rehabilitation Physician
  • Jackson, MS
National Provider Identifier
1790711273
Registry record updated Oct 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
43-278 Issued in MS
Legal business name
MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Doing business as
Methodist Rehab Center
Practice address
1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112
Phone
(601) 981-2611
Fax
(601) 364-5369
NPI assigned
Jun 25, 2006
Last updated
Oct 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2010

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

Authorized official

Name
Mr. Gary Armstrong
Title
Executive Vice President
Phone
(601) 364-3365

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 43-278 MS Primary

Addresses

Primary practice location

1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112

Mailing address

1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112
Phone (601) 981-2611

Other identifiers 1

IdentifierTypeStateIssuer
08420277MedicaidMS

Other names 1

  • Methodist Rehab Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051005001042 MS Part B Supplier - Hospital Department(S) 8921912270 Receives reassigned benefits from 28 practitioners
Practice locations: Flowood, MS; Jackson, MS

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

1 Layfair Dr
Flowood, MS 39232
Phone (601) 718-1132

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
Methodist Rehab CenterJackson, MS, CCN 25T152 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1975

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 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287100800000",
    "number": "1790711273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165112",
            "telephone_number": "601-981-2611",
            "fax_number": "601-364-5369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165112",
            "telephone_number": "601-981-2611",
            "fax_number": "601-364-5369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2010-10-15",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "601-364-3365",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MS",
            "license": "43-278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08420277",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Methodist Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.