Urology Group PC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

UROLOGY GROUP PC

Practice address

401 Southcrest Cir
Suite 201
Southaven, MS 38671

Phone

(662) 349-4329

NPI assigned

May 29, 2008

Organization subpart

No

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

Authorized official

Name

Deborah A Eddlestone

Title

Consultant

Phone

(901) 271-2272

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Urology Group PC

  • Urology Physician
  • Germantown, TN
  • NPI 1053346064

  9739153354

  Same PAC ID
• Urology Group PC

  • Urology Physician
  • West Memphis, AR
  • NPI 1730621624

  9739153354

  Same PAC ID
• Urology Group, PC

  • Clinical Medical Laboratory
  • Marion, AR
  • NPI 1184322067

  9739153354

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Urology Group PC

  • Urology Physician
  • Germantown, TN
  • NPI 1053346064

  O20070129000456

  Same enrollment

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

CLIA laboratory certificates

Tax ID family

Urology Group PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Urology Group PC

  • Urology Physician
  • West Memphis, AR
  • NPI 1730621624
  NPD tax ID
• Urology Group, PC

  • Clinical Medical Laboratory
  • Marion, AR
  • NPI 1184322067
  NPD tax ID

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Walter Rayford, M.D., PHD., FACS

  • Urology Physician
  • Memphis, TN
  • NPI 1821103151

  MS

  Medicare reassignment Care Compare group NPD
• Joseph Andrew Rose, BSN, FNP-BC

  • Family Nurse Practitioner
  • Grenada, MS
  • NPI 1336901594
  Medicare reassignment NPD
• Mark D Greenberger, M.D.

  • Urology Physician
  • Memphis, TN
  • NPI 1497860720

  MS

  Medicare reassignment NPD
• Jessica Joy Lawrence, APN, FNP

  • Nurse Practitioner
  • Memphis, TN
  • NPI 1609100536

  MS

  Medicare reassignment NPD
• Rachelle Latrice Brooks, FNP-C

  • Family Nurse Practitioner
  • Collierville, TN
  • NPI 1689407538

  MS

  Medicare reassignment
• David A Gubin, MD

  • Urology Physician
  • Memphis, TN
  • NPI 1235164286

  MS

  Medicare reassignment

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535500800000",
    "number": "1093973836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 SOUTHCREST CIR",
            "address_2": "SUITE 201",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716726",
            "telephone_number": "662-349-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SOUTHCREST CIR",
            "address_2": "SUITE 201",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "38671",
            "telephone_number": "662-349-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2018-08-29",
        "status": "A",
        "authorized_official_last_name": "EDDLESTONE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "901-271-2272"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09070511",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Unity Hospice NE, LLC
• University of Tennesse
• Upscale Healthcare, LLC
• Upward ABA
• Urgent Medical Clinic Inc
• US PT Texas Inc
• US PT Therapy Services Inc
• USA Vein Clinics of Mississippi LLC
• Usha J. Mehta M.D., P.a.
• Rachana Vaghela, MD

• Urology Physician in Southaven, MS
• Providers in Southaven, MS by specialty
• Urology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; 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.