NPIMap

Individual provider Active NPI

David Newell Duddleston, M.D.

  • Internal Medicine Physician
  • Madison, MS
National Provider Identifier
1003840539
Registry record updated Nov 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10654 Issued in MS
Practice address
128 Chadwyck PL
Madison, MS 39110-6508
Phone
(601) 291-1993
Fax
(601) 321-2682
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 10654 MS
Internal Medicine Physician 207R00000X 10654 MS Primary

Addresses

Primary practice location

128 Chadwyck PL
Madison, MS 39110-6508

Mailing address

128 Chadwyck PL
Madison, MS 39110-6508
Phone (601) 291-1993

Other identifiers 1

IdentifierTypeStateIssuer
00015358MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061115000247 MS Practitioner - Internal Medicine 0143228775 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
10654MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grenada Physician Services, LLC CurrentSince Oct 13, 2019 Accepting new patients
Medical Foundation of Central Ms CurrentSince Jun 1, 2006 Accepting new patients
Medical Foundation of Central Mississippi, Inc. Internal Medicine Current Accepting new patients
Mississippi Baptist Medical Center, Inc. Current Accepting new patients
Mississippi Baptist Medical Center, Inc. CurrentSince Dec 1, 2015 Accepting new patients
Comprehensive Hospitalists of Ms, LLC CurrentSince May 1, 2015 Accepting new patients
Comprehensive Hospitalists of Ms, LLC Current Accepting new patients
Mississippi Baptist Medical Center, Inc CurrentSince Dec 1, 2015 Accepting new patients
Comprehensive Hospitalists of Ms, LLC Internal Medicine CurrentSince May 1, 2015 Accepting new patients
University Internal Medicine Assoc LLP Internal Medicine Past Accepting new patients

Locations

1105 Earl Frye Blvd
Amory, MS 38821
Phone (662) 256-7111

960 Avent Dr
Grenada, MS 38901
Phone (662) 227-7000

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

401 Baptist Dr
Ste 104
Madison, MS 39110
Phone (601) 605-2383

Interoperability endpoints

  • Direct secure messaging: dduddleston63169@ummc.direct-ci.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573430400000",
    "number": "1003840539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 CHADWYCK PL",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106508",
            "telephone_number": "601-291-1993",
            "fax_number": "601-321-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 CHADWYCK PL",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106508",
            "telephone_number": "601-291-1993",
            "fax_number": "601-321-2682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDDLESTON",
        "first_name": "DAVID",
        "middle_name": "NEWELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2019-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "10654",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "10654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00015358",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

Verify at the official NPI Registry.