MISSISSIPPI MEDICAL CLINIC OF MENDEHALL — NPI 1093499907 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers

CMS-1500 Box 24J / 33a • NPI

1093499907

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

363L00000X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner

Box 32 Service Location & ZIP+4

2170 SIMPSON HIGHWAY 49, MENDENHALL, MS, 39114-5418

✓ 9-Digit EDI 837 ZIP+4 (39114-5418)

Practice Phone & Referral Fax

(601) 675-1200

Fax: (601) 375-1209

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1093499907 (MISSISSIPPI MEDICAL CLINIC OF MENDEHALL) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1093499907` (NPI-2 Organization / Facility)
Provider / Legal Name	MISSISSIPPI MEDICAL CLINIC OF MENDEHALL
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner NUCC Code: `363L00000X` (Nurse Practitioner)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2170 SIMPSON HIGHWAY 49, MENDENHALL, MS, 39114-5418
Practice Telephone / Fax	Tel: (601) 675-1200 \| Fax: (601) 375-1209
Administrative Mailing Address	PO BOX 335, MAGEE, MS, 39111-0335
Enumeration & Last Sync	Enumerated: 2023-06-12 \| CMS Record Updated: 2024-02-16
Authorized Official	CHANTE FERGUSON (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2170 SIMPSON HIGHWAY 49, MENDENHALL, MS, 39114-5418

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Plain-English Taxonomy & CMS Crosswalk (363L00000X)

What Does Taxonomy Code 363L00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363L00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MISSISSIPPI MEDICAL CLINIC OF MENDEHALL)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MISSISSIPPI MEDICAL CLINIC OF MENDEHALL (NPI #1093499907)