NPIMap

Organization Active NPI

Orthopaedic Institute of North Mississippi, LLC

  • Orthopaedic Surgery Physician
  • Tupelo, MS
National Provider Identifier
1790755320
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
ORTHOPAEDIC INSTITUTE OF NORTH MISSISSIPPI, LLC
Practice address
499 Gloster Creek VLG Ste G1
Tupelo, MS 38801-4751
Phone
(662) 377-2663
Fax
(662) 840-5856
NPI assigned
Jan 25, 2006
Last updated
Dec 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Authorized official

Name
Stephen Southworth, MDNPI 1437120730
Title
MD
Phone
(662) 377-2663

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X

Addresses

Primary practice location

499 Gloster Creek VLG Ste G1
Tupelo, MS 38801-4751

Mailing address

499 Gloster Creek VLG Ste G1
Tupelo, MS 38801-4751
Phone (662) 377-2663

Other identifiers 1

IdentifierTypeStateIssuer
09016127MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040430000679 MS Part B Supplier - Clinic/Group Practice 7113914078 Receives reassigned benefits from 14 practitioners
Practice locations: Tupelo, MS
O20100930036257 MS DME Supplier - Sports Medicine 7113914078 Practice locations: Tupelo, MS
O20251023001957 AL Part B Supplier - Clinic/Group Practice 7113914078 Receives reassigned benefits from 1 practitioner
Practice locations: Winfield, AL

National Provider Directory

National Provider Directory

Locations

602 W Bankhead St
Ste C
New Albany, MS 38652

Interoperability endpoints

  • Direct secure messaging: barryclark@oa.exscribedirect.com
  • Direct secure messaging: ericlewis@oa.exscribedirect.com
  • Direct secure messaging: nelsthorderson@oa.exscribedirect.com
  • Direct secure messaging: bryanfagn@oa.exscribedirect.com
  • Direct secure messaging: gaberulewicz@oa.exscribedirect.com
  • Direct secure messaging: williampillow@oa.exscribedirect.com
  • Direct secure messaging: stephensouthworth@oa.exscribedirect.com

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639008000000",
    "number": "1790755320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG STE G1",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014751",
            "telephone_number": "662-377-2663",
            "fax_number": "662-840-5856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG STE G1",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014751",
            "telephone_number": "662-377-2663",
            "fax_number": "662-840-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDIC INSTITUTE OF NORTH MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A",
        "authorized_official_last_name": "SOUTHWORTH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "662-377-2663",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016127",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 9, 2021; 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.