PREMISE HEALTH OF MISSISSIPPI MEDICAL PC — NPI 1194140368 (Licensed & Credentialed Allopathic & Osteopathic Physicians

CMS-1500 Box 24J / 33a • NPI

1194140368

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

208D00000X (CMS 01)

Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice

Box 32 Service Location & ZIP+4

305 HIGHWAY 346, ECRU, MS, 38841-9772

✓ 9-Digit EDI 837 ZIP+4 (38841-9772)

Practice Phone & Referral Fax

(662) 489-2669

Fax: (662) 489-2670

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1194140368 (PREMISE HEALTH OF MISSISSIPPI MEDICAL PC) 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	`1194140368` (NPI-2 Organization / Facility)
Provider / Legal Name	PREMISE HEALTH OF MISSISSIPPI MEDICAL PC
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice NUCC Code: `208D00000X` (General Practice)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	305 HIGHWAY 346, ECRU, MS, 38841-9772
Practice Telephone / Fax	Tel: (662) 489-2669 \| Fax: (662) 489-2670
Administrative Mailing Address	5500 MARYLAND WAY STE 120, BRENTWOOD, TN, 37027-4993
Enumeration & Last Sync	Enumerated: 2014-02-25 \| CMS Record Updated: 2026-02-03
Authorized Official	EDWARD SCHWARTZ (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

305 HIGHWAY 346, ECRU, MS, 38841-9772

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Plain-English Taxonomy & CMS Crosswalk (208D00000X)

What Does Taxonomy Code 208D00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 208D00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 01 (Physician/General Practice) • CMS Code 99 (Physician/Undefined Physician type[6])
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified General Practice for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (PREMISE HEALTH OF MISSISSIPPI MEDICAL PC)

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
`208D00000X` — General Practice Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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PREMISE HEALTH OF MISSISSIPPI MEDICAL PC (NPI #1194140368)