NPIMap

Organization Active NPI

North Mississippi Medical Center

  • Pulmonary Disease Physician
  • Tupelo, MS
National Provider Identifier
1811089980
Registry record updated Aug 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
NORTH MISSISSIPPI MEDICAL CENTER
Practice address
830 S Gloster St
Tupelo, MS 38801-4934
Phone
(662) 377-4685
Fax
(662) 377-2755
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2007

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

Authorized official

Name
Gerald Wages
Title
Coo
Phone
(662) 377-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

830 S Gloster St
Tupelo, MS 38801-4934

Mailing address

PO Box 4018
Tupelo, MS 38803-4018
Phone (662) 377-4685

Other identifiers 2

IdentifierTypeStateIssuer
C03168OtherMSMEDICARE GROUP NUMBER
09420762MedicaidMS

Other names 1

  • Sleep Lab 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

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186099200000",
    "number": "1811089980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4018",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388034018",
            "telephone_number": "662-377-4685",
            "fax_number": "662-377-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014934",
            "telephone_number": "662-377-4685",
            "fax_number": "662-377-2755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MISSISSIPPI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-08-03",
        "status": "A",
        "authorized_official_last_name": "WAGES",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "662-377-3000"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "C03168",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09420762",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sleep Lab",
            "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 Aug 3, 2007; 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.