NPIMap

Organization Active NPI

Mississippi Methodist Hospital & Rehabilitation Center, Inc.

Doing business as Methodist Rehab Center

  • Rehabilitation Hospital Unit
  • Jackson, MS
National Provider Identifier
1942359765
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
43-278 Issued in MS
Legal business name
MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Doing business as
Methodist Rehab Center
Practice address
1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112
Phone
(601) 981-2611
NPI assigned
Jan 10, 2007
Last updated
Nov 17, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

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

Authorized official

Name
Gary Armstrong
Title
Exec Vice President
Phone
(601) 981-2611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 43-278 MS Primary

Addresses

Primary practice location

1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112

Mailing address

1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112
Phone (601) 981-2611

Other identifiers 1

IdentifierTypeStateIssuer
00020223MedicaidMS

Other names 1

  • Methodist Rehab Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081117000576 MS Part A Provider - Hospital 8921912270 Practice locations: Jackson, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942359765. Details of each certification follow.

Hospital certification: CCN 25T152

Legal name
MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.
Doing business as
METHODIST REHAB CENTER
Organization structure
CorporationNon-profit
Incorporated
May 27, 1969 in MS
Enrollment address
1350 E Woodrow Wilson Ave
Jackson, MS 39216-5112
Main/Primary Hospital Location
Hospital subgroups
General, Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Mississippi Methodist Rehabilitation CenterCCN 25T152 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Ms Methodist Rehab Center14 organizations share this tax ID, including this one
Part of
Ms Methodist Rehab Center

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gary Armstrong Individual Corporate OfficerExec VP Finance Jul 1, 2002
Corporate Director Jul 1, 2002
W-2 Managing EmployeeCfo Jul 1, 2002
Mississippi Methodist Hospital & Rehabilitation Center, Inc. Organization, Jackson, MS Medical provider/supplier 5% Or Greater Direct Ownership Interest Jan 1, 1975 100%

Owners & managing parties with NPI records 13

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 13

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.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226880000000",
    "number": "1942359765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165112",
            "telephone_number": "601-981-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165112",
            "telephone_number": "601-981-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSISSIPPI METHODIST HOSPITAL & REHABILITATION CENTER, INC.",
        "enumeration_date": "2007-01-10",
        "last_updated": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "EXEC VICE PRESIDENT",
        "authorized_official_telephone_number": "601-981-2611"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MS",
            "license": "43-278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020223",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Methodist Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.