NPIMap

Individual provider Active NPI

John Coleman, MD

  • Internal Medicine Physician
  • Forest, MS
National Provider Identifier
1063945475
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
27688 Issued in MS
Practice address
505 Airport Rd Ste B
Forest, MS 39074-4030
Phone
(601) 469-4771
Fax
(601) 469-4724
NPI assigned
Apr 4, 2017
Last updated
Nov 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 27688 MS Primary

Addresses

Primary practice location

505 Airport Rd Ste B
Forest, MS 39074-4030

Mailing address

3500 Lakeland Dr Ste 515
Flowood, MS 39232-3017
Phone (601) 939-2978

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
I20200727001082 MS Practitioner - Internal Medicine 6406129188 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Mississippi School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1123 Hwy 35 S
Suite 3
Forest, MS 39074-8829
Phone 6014694151356

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Healthcare Management, Inc. CurrentSince Jun 2, 2020 Accepting new patients
Independent Healthcare Management, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Independent Healthcare Management, Inc. CurrentSince Jun 2, 2020 Accepting new patients
Independent Healthcare Management, Inc. Past Accepting new patients
Smith County LTC, LLC Past Accepting new patients
Bedford Care Center of Newton, LLC Past Accepting new patients
Scott County LTC, Inc. Past Accepting new patients

Locations

330 N Broad St
Forest, MS 39074
Phone (601) 469-4151

330 N Broad St
#S
Forest, MS 39074
Phone (601) 469-4151

505 Airport Rd
Ste B
Forest, MS 39074
Phone (601) 469-4771

100 Pioneer Way
Magee, MS 39111
Phone 6018496440245

110 Pioneer Way
Magee, MS 39111

342 Magnolia Dr
Raleigh, MS 39153
Phone (601) 782-5665

Networks

  • LA PPO C-SNP

Interoperability endpoints

  • Direct secure messaging: john.coleman@phspch.eclinicaldirectplus.com

Organizations & group practices 7

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1063945475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 LAKELAND DR STE 515",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392323017",
            "telephone_number": "601-939-2978",
            "fax_number": "601-978-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 AIRPORT RD STE B",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390744030",
            "telephone_number": "601-469-4771",
            "fax_number": "601-469-4724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-04",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "27688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, MS

Sources for this page

Verify at the official NPI Registry.