NPIMap

Individual provider Active NPI

Marshall Scott Tynes, DO

  • Family Medicine Physician
  • Meridian, MS
National Provider Identifier
1063509719
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14897 Issued in MS
Practice address
1600 22ND Ave
Medical Towers III
Meridian, MS 39301-3223
Phone
(601) 483-5322
Fax
(601) 581-2289
NPI assigned
Oct 6, 2006
Last updated
Oct 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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 14897 MS Primary

Addresses

Primary practice location

1600 22ND Ave
Medical Towers III
Meridian, MS 39301-3223

Mailing address

PO Box 749215
Atlanta, GA 30374-9215
Phone (901) 226-3186

Other identifiers 4

IdentifierTypeStateIssuer
009700450OtherALALMCD
073075294TYNOtherALAL BCBS
0117444MedicaidMS
279588OtherTRICARE

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
I20101004000758 MS Practitioner - Family Practice 9032297072 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Physician Alliance IncGroup PAC ID 3274727318, 69 clinicians
Wayne General HospitalGroup PAC ID 2668457581, 47 clinicians

Practice addresses (Care Compare)

1600 22ND Ave
Suite a
Meridian, MS 39301-3223
Phone (601) 693-1055

951 Matthew Dr
Suite a
Waynesboro, MS 39367-2566
Phone (601) 735-2401

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wayne General Hospital Current Accepting new patients
Wayne General Hospital Family Medicine CurrentSince Nov 1, 2025 Accepting new patients
Wayne General Hospital CurrentSince Nov 1, 2025 Accepting new patients
Anderson Physician Alliance, Inc. Family Medicine CurrentSince Aug 1, 2024 Accepting new patients
Urology Clinic of Meridian, P.a. Current Accepting new patients
Joel T Callahan Thomas H Greer Jr & a Gary Boone PTR CurrentSince Jan 28, 2013 Accepting new patients
Wayne General Hospital Family Medicine Past Accepting new patients
Mississippi Family Medicine P C PastSince Feb 1, 2016 Accepting new patients
Wayne General Hospsital Past Accepting new patients

Locations

1600 22nd Ave
Meridian, MS 39301
Phone (601) 483-5322

1600 22nd Ave
#3
Meridian, MS 39301
Phone (601) 693-1055

950 Matthew Dr
Waynesboro, MS 39367
Phone (601) 735-5151

951 Matthew Dr
Ste A
Waynesboro, MS 39367
Phone (601) 735-2401

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: mtynes626565@direct.bmhcc.org
  • Direct secure messaging: stynes@imc.directbygreenway.com

Organizations & group practices 9

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 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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1063509719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749215",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749215",
            "telephone_number": "901-226-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 22ND AVE",
            "address_2": "MEDICAL TOWERS III",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393013223",
            "telephone_number": "601-483-5322",
            "fax_number": "601-581-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYNES",
        "first_name": "MARSHALL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "14897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALMCD",
            "identifier": "009700450",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AL BCBS",
            "identifier": "073075294TYN",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0117444",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "279588",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, MS

Sources for this page

Verify at the official NPI Registry.