NPIMap

Organization Active NPI

Regenerative Medical Group Inc

  • Family Medicine Physician
  • Booneville, MS
National Provider Identifier
1821557281
Registry record updated Mar 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
REGENERATIVE MEDICAL GROUP INC
Practice address
2005 N 2ND St
Booneville, MS 38829-7728
Phone
(662) 416-3306
NPI assigned
Mar 15, 2019
Last updated
Mar 15, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
REGENERATIVE MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2019

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

Authorized official

Name
Bryn Jarald HendersonNPI 1447296694
Title
Owner
Phone
(714) 639-4012

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2005 N 2ND St
Booneville, MS 38829-7728

Mailing address

615 E Chapman Ave
Orange, CA 92866-1643

Other names 1

  • Regenerative Medical Group Other name

National Provider Directory

National Provider Directory
Tax ID family
Regenerative Med Group Inc7 organizations share this tax ID, including this one
Part of
Regenerative Med Group Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2005 N 2nd St
Booneville, MS 38829
Phone (662) 416-3306

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552608000000",
    "number": "1821557281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 E CHAPMAN AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928661643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388297728",
            "telephone_number": "662-416-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENERATIVE MEDICAL GROUP INC",
        "enumeration_date": "2019-03-15",
        "last_updated": "2019-03-15",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "BRYN",
        "authorized_official_middle_name": "JARALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-639-4012"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regenerative Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Booneville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.