NPIMap

Organization Active NPI

Northern Mississippi Vascular Access Center

  • Vascular & Interventional Radiology Physician
  • Greenville, MS
National Provider Identifier
1821861378
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
NORTHERN MISSISSIPPI VASCULAR ACCESS CENTER
Practice address
1502 S Colorado St
Greenville, MS 38703-7219
Phone
(662) 335-4105
NPI assigned
Nov 6, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Authorized official

Name
Jennifer Reed
Title
Administrator
Phone
(662) 335-4105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

1502 S Colorado St
Greenville, MS 38703-7219

Mailing address

PO Box 2120
Ridgeland, MS 39158-2120

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240304002026 MS Part B Supplier - Clinic/Group Practice 5395180020 Receives reassigned benefits from 1 practitioner
Practice locations: Greenwood, MS

National Provider Directory

National Provider Directory

Locations

410 E Washington St
Greenwood, MS 38930
Phone (662) 219-2991

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": "1699228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1821861378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2120",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391582120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 S COLORADO ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037219",
            "telephone_number": "662-335-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MISSISSIPPI VASCULAR ACCESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-335-4105"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.