Active NPI
Robert Herndon, M.D.
- Neurology Physician
- Jackson, MS
National Provider Identifier
1124034590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 15210
- Practice address
- 2500 North State Street
Jackson, MS 39216 - Phone
- (601) 984-5500
- Fax
- (601) 984-5499
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 15210 | MS | Primary |
Addresses
Primary practice location
2500 North State Street
Jackson, MS 39216
Mailing address
2500 North State Street
Jackson, MS 39216
Phone (601) 984-5500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01233213 | Other | MS | RAILROAD MEDICARE |
| 0121287 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Neurology Group, PLLC | Neurology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387152000000",
"number": "1124034590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 NORTH STATE STREET",
"city": "JACKSON",
"state": "MS",
"postal_code": "39216",
"telephone_number": "601-984-5500",
"fax_number": "601-984-5499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 NORTH STATE STREET",
"city": "JACKSON",
"state": "MS",
"postal_code": "39216",
"telephone_number": "601-984-5500",
"fax_number": "601-984-5499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERNDON",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2013-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MS",
"license": "15210",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01233213",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0121287",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.