ENT Surgical Group, PLLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

ENT SURGICAL GROUP, PLLC

Practice address

138 Park Place Blvd
Madison, MS 39110

Phone

(601) 898-7500

NPI assigned

Oct 13, 2022

Organization subpart

No

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

Authorized official

Name

Kyle Gordon, MDNPI 1811076938

Title

Owner

Phone

(601) 898-7500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Ford Gordon, MD

  • Otolaryngology Physician
  • Jackson, MS
  • NPI 1811076938
  Medicare reassignment Care Compare group NPD Authorized official
• Bryan McRae Clay, MD

  • Otolaryngology Physician
  • Jackson, MS
  • NPI 1730268764
  Medicare reassignment Care Compare group NPD
• Margaux Antoine Nelms, AU.D.

  • Audiologist
  • Madison, MS
  • NPI 1215662887
  Medicare reassignment Care Compare group NPD
• Jess Clifton Roberts, M.D.

  • Otolaryngology Physician
  • Jackson, MS
  • NPI 1336393891
  Medicare reassignment Care Compare group NPD
• Alicia Wells

  • Audiologist
  • Jackson, MS
  • NPI 1699058420
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1023734878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 PARK PLACE BLVD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 PARK PLACE BLVD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110",
            "telephone_number": "601-898-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENT SURGICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-898-7500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven W Easley, M.D.
• Melinda Edwards, LCSW
• Elizabeth Mitchell Eyecare PA
• Parker L. Ellison, M.D.
• Enduracare Acute Care Services LLC
• Ethos Rehab LLC
• Eric Christopher Evans, M.D.
• Everyday Nutrition
• Glenda Gilmer Ezell, LPC
• Family Coaching Clinic

• Otolaryngology Physician in Madison, MS
• Providers in Madison, MS by specialty
• Otolaryngology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.