NPIMap

Organization Active NPI

Cary N Mettetal

Doing business as Mettetal Family Medicine

  • Family Medicine Physician
  • Sardis, MS
National Provider Identifier
1083786727
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CARY N METTETAL
Doing business as
Mettetal Family Medicine
Practice address
401 E Lee St
Sardis, MS 38666-1227
Phone
(662) 487-0004
Fax
(662) 487-0006
NPI assigned
Nov 15, 2006
Last updated
Jun 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Authorized official

Name
Penny Harrison
Title
Office Manager
Phone
(662) 487-0004

Specialties & licenses 1

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

Addresses

Primary practice location

401 E Lee St
Sardis, MS 38666-1227

Mailing address

401 E Lee St
Sardis, MS 38666-1227
Phone (662) 487-0004

Other identifiers 1

IdentifierTypeStateIssuer
09015623MedicaidMS

Other names 1

  • Mettetal Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040709000707 MS Part B Supplier - Clinic/Group Practice 3072591791 Receives reassigned benefits from 5 practitioners
Practice locations: Sardis, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0869512Mettetal Family Medicine401 E Lee St, Sardis, MS 38666ComplianceSep 20, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

401 E Lee St
#B
Sardis, MS 38666
Phone (662) 487-0004

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685577600000",
    "number": "1083786727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E LEE ST",
            "city": "SARDIS",
            "state": "MS",
            "postal_code": "386661227",
            "telephone_number": "662-487-0004",
            "fax_number": "662-487-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E LEE ST",
            "city": "SARDIS",
            "state": "MS",
            "postal_code": "386661227",
            "telephone_number": "662-487-0004",
            "fax_number": "662-487-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARY N METTETAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "PENNY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "662-487-0004"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015623",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mettetal Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mettetal Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sardis, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.