Individual provider Active NPI

Firas Mourad

  • Prosthodontics
  • Ridgeland, MS
National Provider Identifier
1932639077
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
6043-23 Issued in MS
Practice address
230 Trace Colony Park Dr Ste 1
Ridgeland, MS 39157-8851
Phone
(601) 707-3878
NPI assigned
Jun 12, 2017
Last updated
Jan 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 6043-23 MS Primary

Addresses

Primary practice location

230 Trace Colony Park Dr Ste 1
Ridgeland, MS 39157-8851

Mailing address

230 Trace Colony Park Dr Ste 1
Ridgeland, MS 39157-8851
Phone (601) 707-3878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191107002902 MS Practitioner - Dentist 5991137267 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6043-23MSMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Nov 1, 2019 Accepting new patients

Locations

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

2500 N State St
#4200
Jackson, MS 39216

Interoperability endpoints

  • Direct secure messaging: fmourad126611@ummc.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1932639077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 TRACE COLONY PARK DR STE 1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578851",
            "telephone_number": "601-707-3878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 TRACE COLONY PARK DR STE 1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578851",
            "telephone_number": "601-707-3878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOURAD",
        "first_name": "FIRAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-12",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MS",
            "license": "6043-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

Verify at the official NPI Registry.