NPIMap

Organization Active NPI

Mississippi Urology Clinic, PLLC

  • Urology Physician
  • Jackson, MS
National Provider Identifier
1902837313
Registry record updated Oct 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
MISSISSIPPI UROLOGY CLINIC, PLLC
Practice address
501 Marhsall St
Suite 301
Jackson, MS 39202
Phone
(601) 353-9900
Fax
(601) 985-3199
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2018

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

Authorized official

Name
Jerry Kempf Poole, RN, FACHE
Title
Chief Administrative Officer
Phone
(601) 985-3169

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

501 Marhsall St
Suite 301
Jackson, MS 39202

Mailing address

501 Marhsall St
Suite 301
Jackson, MS 39202
Phone (601) 353-9900

Other identifiers 1

IdentifierTypeStateIssuer
CD5655OtherMSMEDICARE RR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040614001229 MS Part B Supplier - Clinic/Group Practice 6406830942 Receives reassigned benefits from 15 practitioners
Practice locations: Hazlehurst, MS; Vicksburg, MS; Magee, MS; Kosciusko, MS; Jackson, MS; Flowood, MS; Crystal Springs, MS; Carthage, MS

National Provider Directory

National Provider Directory

Locations

123 Bo Bo Dr
Crystal Springs, MS 39059
Phone (601) 892-2225

1040 River Oaks Dr
Ste 202
Jackson, MS 39232

1421 N State St
Ste 403
Jackson, MS 39202
Phone (601) 353-9909

Interoperability endpoints

  • Direct secure messaging: kieranhynes@muc.medalliesdirect.net
  • Direct secure messaging: williamslay@muc.medalliesdirect.net
  • Direct secure messaging: patrickdaily@muc.medalliesdirect.net
  • Direct secure messaging: katlynamason@muc.medalliesdirect.net
  • Direct secure messaging: melaniefurr@muc.medalliesdirect.net
  • Direct secure messaging: matthewmoss@muc.medalliesdirect.net
  • Direct secure messaging: elizabethlishman@muc.medalliesdirect.net
  • Direct secure messaging: kimberlyloe@muc.medalliesdirect.net
  • Direct secure messaging: allenharaway@muc.medalliesdirect.net
  • Direct secure messaging: markrunnels@muc.medalliesdirect.net
  • Direct secure messaging: johnadams@muc.medalliesdirect.net
  • Direct secure messaging: cullenshows@muc.medalliesdirect.net
  • Direct secure messaging: haroldblalock@muc.medalliesdirect.net
  • Direct secure messaging: sethstuart@muc.medalliesdirect.net

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539216000000",
    "number": "1902837313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MARHSALL ST",
            "address_2": "SUITE 301",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39202",
            "telephone_number": "601-353-9900",
            "fax_number": "601-985-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MARHSALL ST",
            "address_2": "SUITE 301",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39202",
            "telephone_number": "601-353-9900",
            "fax_number": "601-985-3199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI UROLOGY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2018-10-11",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "KEMPF",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "601-985-3169",
        "authorized_official_credential": "RN, FACHE"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CD5655",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; 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.