NPIMap

Individual provider Active NPI

Evan J. Pickus, M.D.

  • Plastic Surgery Physician
  • Carthage, MS
National Provider Identifier
1073545554
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
17806 Issued in MS
Practice address
310 Ellis St
Carthage, MS 39051-3809
Phone
(601) 740-2785
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 17806 MS Primary
Emergency Medicine Physician 207P00000X 17806 MS

Addresses

Primary practice location

310 Ellis St
Carthage, MS 39051-3809

Mailing address

6424 Central City Blvd Apt 534
Galveston, TX 77551-8007
Phone (601) 740-2785

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
I20041221000439 MS Practitioner - Emergency Medicine 3375501471 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Howard University College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Leake Emergency Group, LLCGroup PAC ID 4486985256, 15 clinicians
WMC Emergency Services LLCGroup PAC ID 5698102465, 13 clinicians

Practice addresses (Care Compare)

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

17550 E Main St
Louisville, MS 39339-2772
Phone (662) 446-1072

Hospital & facility affiliations

  • Winston Medical Center Hospital, Louisville, MS, CCN 250027
  • Baptist Medical Center-Leake Hospital, Carthage, MS, CCN 251315

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
WMC Emergency Services LLC CurrentSince Dec 18, 2019 Accepting new patients
Covington County Hospital CurrentSince Oct 1, 2014 Accepting new patients
Covington County Hospital CurrentSince Oct 1, 2014 Accepting new patients
Correct Care, Inc. Emergency Medicine CurrentSince Dec 4, 2013 Accepting new patients
Leake Emergency Group, LLC Emergency Medicine CurrentSince Jun 28, 2022 Accepting new patients
Pontotoc Health Services, Inc. CurrentSince Mar 31, 2015 Accepting new patients
Pontotoc Health Services, Inc. CurrentSince Mar 31, 2015 Accepting new patients
Attala Emergency Group LLC Emergency Medicine CurrentSince Sep 4, 2012 Accepting new patients
Choctaw Regional Medical Center CurrentSince Oct 1, 2021 Accepting new patients
Baptist Medical Center-Leake, Inc Past Accepting new patients
Keystone Medical Services of Ms, Inc Emergency Medicine Past Accepting new patients

Locations

229 Saint John Ln
Covington, LA 70433
Phone (866) 875-9225

8613 MS Highway 12
Ackerman, MS 39735
Phone (662) 285-4400

1100 Highway 16 E
Carthage, MS 39051
Phone (601) 267-1100

3275 Highway 49
Ste E
Collins, MS 39428
Phone (601) 765-6292

220 Highway 12 W
Kosciusko, MS 39090
Phone (662) 289-4311

17550 E Main St
Louisville, MS 39339
Phone (662) 446-1072

176 S Main St
Pontotoc, MS 38863
Phone (601) 489-5510

409 Tyler Holmes Dr
Winona, MS 38967
Phone (662) 283-3060

Interoperability endpoints

  • Direct secure messaging: evan.pickus.1@15070.direct.athenahealth.com
  • FHIR API: https://fhir-usa.unify.chbase.com/org/covingc-3983785e
  • Direct secure messaging: epickus523016@direct.bmhcc.org

Organizations & group practices 11

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 2

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1073545554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 CENTRAL CITY BLVD APT 534",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775518007",
            "telephone_number": "601-740-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 ELLIS ST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390513809",
            "telephone_number": "601-740-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKUS",
        "first_name": "EVAN",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MS",
            "license": "17806",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "17806",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, MS

Sources for this page

Verify at the official NPI Registry.