NPIMap

Individual provider Active NPI

William Douglas Perry, MD

  • Family Medicine Physician
  • Walnut Grove, MS
National Provider Identifier
1033196977
Registry record updated Mar 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12146 Issued in MS
Practice address
110 Park St
Walnut Grove, MS 39189-6526
Phone
(601) 267-1406
Fax
(601) 267-5422
NPI assigned
Dec 30, 2005
Last updated
Mar 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12146 MS Primary

Addresses

Primary practice location

110 Park St
Walnut Grove, MS 39189-6526

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446
Phone (901) 227-3255

Other practice location 1

110 Park Street
Walnut Grove, MS 39189
Phone (601) 253-0173

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
I20070613000015 MS Practitioner - Family Practice 8921901794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 Park St
Walnut Grove, MS 39189-6526
Phone (601) 253-0173

1100 Hwy 16 E
Carthage, MS 39051-4222
Phone (601) 267-1470

242 Thaggard Rd
Madden, MS 39109
Phone (601) 267-1320

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Medical Center-Leake, Inc Family Medicine CurrentSince Nov 9, 2011 Accepting new patients
Hilltop Mississippi Healthcare LLC PastSince Oct 15, 2012 Accepting new patients
Trend Health and Rehab of Carthage Past Accepting new patients
Carthage Senior Care Past Accepting new patients
101 Kirkland Street Opco LLC Past Accepting new patients

Locations

302 Ellis St
Carthage, MS 39051
Phone (601) 267-1100

Interoperability endpoints

  • Direct secure messaging: wperry149084@direct.bmhcc.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hilltop Manor Health and RehabilitationUnion, MS, CCN 255260 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2025
May 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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

Hospital & facility affiliations 10

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": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520380800000",
    "number": "1033196977",
    "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",
            "telephone_number": "901-227-3255",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PARK ST",
            "city": "WALNUT GROVE",
            "state": "MS",
            "postal_code": "391896526",
            "telephone_number": "601-267-1406",
            "fax_number": "601-267-5422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Park Street",
            "address_purpose": "LOCATION",
            "city": "Walnut Grove",
            "state": "MS",
            "postal_code": "39189",
            "country_code": "US",
            "telephone_number": "601-253-0173",
            "fax_number": "601-253-0176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERRY",
        "first_name": "WILLIAM",
        "middle_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2018-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "12146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Grove, MS

Sources for this page

Verify at the official NPI Registry.