NPIMap

Organization Active NPI

Ortho Express Holding Company, LLC

Doing business as OrthoXpress Bone & Joint Center of Booneville

  • Nurse Practitioner
  • Booneville, MS
National Provider Identifier
1962029249
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ORTHO EXPRESS HOLDING COMPANY, LLC
Doing business as
OrthoXpress Bone & Joint Center of Booneville
Practice address
608 W Church St
Booneville, MS 38829
Phone
(662) 534-2227
Fax
(662) 534-2330
NPI assigned
Jul 2, 2020
Last updated
Sep 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Authorized official

Name
Jennifer C Bullock
Title
President
Phone
(662) 534-2227

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

608 W Church St
Booneville, MS 38829

Mailing address

206 Oxford Rd
New Albany, MS 38652-3115
Phone (662) 534-2227

Other names 1

  • OrthoXpress Bone & Joint Center of Booneville Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address zach.glenn.1@11099.direct.athenahealth.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200923001417 MS DME Supplier - Physician - Orthopedic/Orthopedic Surgery 1951724392 Practice locations: Booneville, MS

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Ortho Express Holding Co7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1593648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757462400000",
    "number": "1962029249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 OXFORD RD",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386523115",
            "telephone_number": "662-534-2227",
            "fax_number": "662-534-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 W CHURCH ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "38829",
            "telephone_number": "662-534-2227",
            "fax_number": "662-534-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO EXPRESS HOLDING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-02",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-534-2227"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "zach.glenn.1@11099.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "608 W Church St",
            "city": "Booneville",
            "state": "MS",
            "country_code": "US",
            "postal_code": "38829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "OrthoXpress Bone & Joint Center of Booneville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OrthoXpress Bone & Joint Center of Booneville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Booneville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; 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.