Taysir M. Abusaa, M.S., M.D.
Individual provider Active NPI Pediatric Emergency Medicine (Pediatrics) Physician · Jackson, MS
NPI 1124062492 · NPPES record last updated Aug 22, 2023
Key facts
- NPI
- 1124062492
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X
- License
- W0715043 (MS)
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-2000
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080628000109 | MS | Practitioner - Pediatric Medicine | 4587736038 | Reassigns benefits to 1 organization |
| I20231011003369 | ME | Practitioner - Pediatric Medicine | 4587736038 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| W0715043 | MS | MD | Pediatric Emergency Medicine (Pediatrics) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| Pines Health Services | Current |
Accepting new patients | |
| Pines Health Services | Current |
Accepting new patients | |
| Pines Health Services | Past | Accepting new patients | |
| City of Caribou | Past | Accepting new patients | |
| State of Mississippi-University of Mississippi Medical Center | Past | Accepting new patients | |
| University Radiation Oncology Consultants, PLLC | Past | Accepting new patients |
Locations
163 Van Buren Rd
Ste 4
Caribou, ME 04736
Phone (207) 492-3451
74 Access Hwy
Caribou, ME 04736
Phone (207) 498-2350
163 Van Buren Rd
Caribou, ME 04736
Phone (207) 498-1320
163 Van Buren Rd
Ste 1
Caribou, ME 04736
Phone (207) 498-1227
960 Avent Dr
#J
Grenada, MS 38901
Phone (662) 227-6450
1815 Hospital Dr
Jackson, MS 39204
Phone (601) 815-4775
2500 N State St
Jackson, MS 39216
Phone (601) 815-4775
Interoperability endpoints
- tabusaa6194@ummc.direct-ci.com
- tabusaa651363@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Emergency Medicine (Pediatrics) Physician | 2080P0204X | W0715043 | MS | Yes |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-2000
Other practice location 1
163 Van Buren Rd
Caribou, ME 04736-3567
Phone (207) 492-3451
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00117215 | Medicaid | MS | |
| 1685241 | Medicaid | LA |
Other providers in Jackson, MS
- Timothy Abram
- Dorothy Eva Abrams
- Timothy Alexander Abston
- Abundant Health Services, LLC
- Abundant Nursing Care
- Accessible Physical Therapy LLC
- Acclimate ABA Ms LLC
- Accurate Medical Diagnostics, LLC
- Sally Acebo
- Achieving Stars Ms
All providers in Jackson, MS · Pediatric Emergency Medicine (Pediatrics) Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.