Individual provider Active NPI

Derek Letort, M.D.

  • Neurology Physician
  • Jackson, MS
National Provider Identifier
1023202272
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
20226 Issued in MS
Practice address
1200 N State St Ste 420
Jackson, MS 39202-2027
Phone
(601) 355-3353
Fax
(601) 355-3365
NPI assigned
Aug 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 20226 MS Primary

Addresses

Primary practice location

1200 N State St Ste 420
Jackson, MS 39202-2027

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101013000681 MS Practitioner - Neurology 3678645744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Mississippi School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1151 N State St
Suite 404
Jackson, MS 39202-2457
Phone (601) 292-4261

1200 N State St
Jackson, MS 39202-2027

1225 N State St
Jackson, MS 39202-2064
Phone (601) 292-4261

3011 Greenfield Rd
Pearl, MS 39208-8712
Phone (601) 825-9000

401 Baptist Dr
Suite 104
Madison, MS 39110-2010
Phone (601) 973-1504

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.38 of 100Reported as group
Quality
54.22
Promoting interoperability
100
Improvement activities
40
Cost
73.72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20226MSMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Jackson Heart Cardiology Clinic-Yazoo City CurrentSince Aug 15, 2016 Accepting new patients
Medical Foundation of Central Ms CurrentSince Aug 15, 2016 Accepting new patients
Medical Foundation of Central Mississippi, Inc. Neurology Current Accepting new patients

Locations

1200 N State St
Ste 420
Jackson, MS 39202
Phone (601) 355-3353

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

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

965 Ridge Lake Blvd
Ste 103
Memphis, TN 38120
Phone (901) 227-3221

Networks

  • MS PPO C-SNP
  • MS PPO
  • MS PPO D-SNP

Interoperability endpoints

  • Direct secure messaging: dletort155450@direct.bmhcc.org

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1023202272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 103",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209446",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N STATE ST STE 420",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022027",
            "telephone_number": "601-355-3353",
            "fax_number": "601-355-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LETORT",
        "first_name": "DEREK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-30",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MS",
            "license": "20226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.