NPIMap

Individual provider Active NPI

Brock Nathaniel Banks, M.D.

  • Family Medicine Physician
  • Moss Point, MS
National Provider Identifier
1083147045
Registry record updated Dec 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26056 Issued in MS
Practice address
5907 Highway 90
Moss Point, MS 39563-6536
Phone
(228) 769-2611
NPI assigned
Apr 6, 2017
Last updated
Dec 13, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2022

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 26056 MS Primary

Addresses

Primary practice location

5907 Highway 90
Moss Point, MS 39563-6536

Mailing address

5907 Highway 90
Moss Point, MS 39563-6536
Phone (228) 769-2611

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
I20200716000680 MS Practitioner - Family Practice 1850662982 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
USA Health Community Providers LLCGroup PAC ID 2062875479, 97 clinicians

Practice addresses (Care Compare)

5907 Hwy 90
Moss Point, MS 39563-6536
Phone (228) 769-2611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Oct 1, 2021 Accepting new patients
Forrest County General Hospital CurrentSince Oct 1, 2021 Accepting new patients
Forrest County General Hospital Current Accepting new patients
USA Health Community Providers LLC Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Mississippi Providence Healthcare Services Inc. Family Medicine CurrentSince Aug 1, 2022 Accepting new patients
University of South Alabama Mitchell Cancer Institute Past Accepting new patients

Locations

2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050

415 S 28th Ave
Fl 1
Hattiesburg, MS 39401
Phone (601) 288-5200

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

5907 Highway 90
Pascagoula, MS 39563
Phone (225) 769-1611

Networks

  • LA PPO C-SNP

Interoperability endpoints

  • Direct secure messaging: brock.banks.1@16253.direct.athenahealth.com

Organizations & group practices 6

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 6

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": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1083147045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5907 HIGHWAY 90",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636536",
            "telephone_number": "228-769-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5907 HIGHWAY 90",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636536",
            "telephone_number": "228-769-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANKS",
        "first_name": "BROCK",
        "middle_name": "NATHANIEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-06",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "26056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moss Point, MS

Sources for this page

Verify at the official NPI Registry.