NPIMap

Organization Active NPI

Mississippi Band of Choctaw Indians

  • Nursing Facility/Intermediate Care Facility
  • Choctaw, MS
National Provider Identifier
1891965612
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
583 Issued in MS
Legal business name
MISSISSIPPI BAND OF CHOCTAW INDIANS
Practice address
135 Hospital Cir
Choctaw, MS 39350-6780
Phone
(601) 656-2582
NPI assigned
Mar 7, 2008
Organization subpart
Yes
Parent organization
MISSISSIPPI BAND OF CHOCTAW INDIANSAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Phyllis J Anderson
Title
Tribal Chief
Phone
(601) 656-5251

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 9

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

Practitioners 29

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

View all 29

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040126000871 TX Part B Supplier - Clinic/Group Practice 4385546662 Receives reassigned benefits from 71 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Choctaw, MS; Philadelphia, MS; Conehatta, MS; Carthage, MS

National Provider Directory

National Provider Directory
Tax ID family
Choctaw Health Center Pharmacy (10 organizations share this tax ID)
Part of
Choctaw Health Center Pharmacy

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 583 MS Primary

Addresses

NPPES NPI Registry

Primary practice location

135 Hospital Cir
Choctaw, MS 39350-6780

Mailing address

210 Hospital Cir
Choctaw, MS 39350-6781
Phone (601) 656-2211

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
09015768MedicaidMS

Other names 1

NPPES NPI Registry
  • CHOCTAW RESIDENTIAL CENTER PHYSICIANS Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 2, 2012.

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1891965612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HOSPITAL CIR",
            "city": "CHOCTAW",
            "state": "MS",
            "postal_code": "393506781",
            "telephone_number": "601-656-2211",
            "fax_number": "601-663-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 HOSPITAL CIR",
            "city": "CHOCTAW",
            "state": "MS",
            "postal_code": "393506780",
            "telephone_number": "601-656-2582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI BAND OF CHOCTAW INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSISSIPPI BAND OF CHOCTAW INDIANS",
        "enumeration_date": "2008-03-07",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "TRIBAL CHIEF",
        "authorized_official_telephone_number": "601-656-5251"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MS",
            "license": "583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015768",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHOCTAW RESIDENTIAL CENTER PHYSICIANS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Choctaw, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.