NPIMap

Organization Active NPI

North Mississippi Gilmore Clinics, LLC

  • Pediatrics Physician
  • Amory, MS
National Provider Identifier
1972067288
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTH MISSISSIPPI GILMORE CLINICS, LLC
Practice address
1107 Earl Frye Blvd Ste 5
Amory, MS 38821-5519
Phone
(662) 257-6705
NPI assigned
Jan 31, 2019
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Bruce Toppin
Title
Corporate Secretary
Phone
(662) 377-4229

Other NPIs on the same Medicare enrollment 4

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

Practitioners 15

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

View all 15

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190510000063 MS Part B Supplier - Clinic/Group Practice 2961745195 Receives reassigned benefits from 23 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hamilton, MS; Amory, MS

National Provider Directory

National Provider Directory
Tax ID family
Amory Children'S Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

1107 Earl Frye Blvd Ste 5
Amory, MS 38821-5519

Mailing address

808 Varsity Dr
Tupelo, MS 38801-4613

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
009526887MedicaidMS

Other names 1

NPPES NPI Registry
  • Amory Childrens Clinic 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 Jan 21, 2025.

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1972067288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 VARSITY DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 EARL FRYE BLVD STE 5",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388215519",
            "telephone_number": "662-257-6705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MISSISSIPPI GILMORE CLINICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "TOPPIN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "662-377-4229"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009526887",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amory Childrens Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amory, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.