Irene Buckner, M.D.
Individual provider Active NPI Specialist · Clarksdale, MS
NPI 1003836669 · NPPES record last updated Jan 14, 2019
Key facts
- NPI
- 1003836669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 16074 (MS)
- Practice address
- 1967 Hospital Dr
Clarksdale, MS 38614 - Phone
- (662) 624-5481
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 3
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1967 Hospital Dr
Clarksdale, MS 38614-7203
Phone (662) 624-5481
Hospital & facility affiliations
- Accentcare Home Health of Greenwood
- Northwest Missississippi Regional Medical Center
- Greenbough Health and Rehabilitation Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Greenbough Health and Rehabilitation Center |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Apr 1, 2022 Apr 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040916000920 | MS | Practitioner - Internal Medicine |
9638146798 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16074 | MS | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Internal Medicine Clinic of Clarksdale | Specialist | Current |
Accepting new patients |
| Clarksdale Ms Opco LLC | Past | Accepting new patients | |
| Preferred Care Developmental Centers of Ms I, Inc. | Past | Accepting new patients | |
| Clarksdale Hma LLC | Past | Accepting new patients | |
| Delta Physician Practices | Past | Accepting new patients | |
| 340 Desoto Avenue Ext Operations, LLC | Past | Accepting new patients |
Locations
1967 Hospital Dr
Clarksdale, MS 38614
Phone (601) 627-7361
785 Ohio Ave
Ste 2B
Clarksdale, MS 38614
Phone (601) 624-5481
Interoperability endpoints
- nwmibuckn@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 16074 | MS | Yes |
Addresses
Primary practice location
1967 Hospital Dr
Clarksdale, MS 38614
Mailing address
1967 Hospital Dr
Clarksdale, MS 38614-7203
Other practice location 1
785 Ohio Ave Ste 2B
Clarksdale, MS 38614-6216
Phone (662) 624-5481
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00119669 | Medicaid | MS |
Other providers in Clarksdale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.