NPIMap

Individual provider Active NPI

George Gillespie III, D.O.

  • Family Medicine Physician
  • Petal, MS
National Provider Identifier
1124117171
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19284 Issued in MS
Practice address
50 Parkway LN
Petal, MS 39465-3035
Phone
(601) 544-7404
Fax
(601) 584-6457
NPI assigned
Oct 11, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 19284 MS
Family Medicine Physician 207Q00000X 19284 MS Primary

Addresses

Primary practice location

50 Parkway LN
Petal, MS 39465-3035

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463

Other identifiers 4

IdentifierTypeStateIssuer
6039505OtherMSHEALTHSPRING
9864055OtherMSAETNA
0029455OtherMSCIGNA
05020034MedicaidMS

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
I20070702000147 MS Practitioner - HospitalistPractitioner - Family PracticePractitioner - Emergency Medicine 4082713151 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Magee Benevolent AssociationGroup PAC ID 3678466463, 19 clinicians
Covington County HospitalGroup PAC ID 4183517253, shared by 16 NPIs, 44 clinicians

Practice addresses (Care Compare)

300 3Rd Ave SE
Magee, MS 39111-3665
Phone (601) 849-5070

300 3Rd Ave SE Northwing
Magee, MS 39111-3665
Phone (601) 849-7702

347 Magnolia Dr
Raleigh, MS 39153-6011
Phone (601) 374-9070

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Covington County Hospital CurrentSince Oct 1, 2017 Accepting new patients
Magee Benevolent Association Current Accepting new patients
South Central Regional Medical Center CurrentSince May 1, 2019 Accepting new patients
Covington County Hospital Current Accepting new patients
South Central Regional Medical Center CurrentSince May 1, 2019 Accepting new patients
Covington County Hospital CurrentSince Oct 1, 2017 Accepting new patients
Covington County Hospital Past Accepting new patients
Tishomingo Health Services, Inc. Past Accepting new patients
North Ms Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

3275 Highway 49
Ste E
Collins, MS 39428
Phone (601) 765-6292

300 SE 3rd Ave
Magee, MS 39111
Phone (601) 849-5070

347 Magnolia Dr
Raleigh, MS 39153
Phone (601) 374-9070

Interoperability endpoints

  • Direct secure messaging: george.gillespie.1@15070.direct.athenahealth.com
  • FHIR API: https://fhir-usa.unify.chbase.com/org/covingc-3983785e

Organizations & group practices 9

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 7

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1124117171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-579-5463",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 PARKWAY LN",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394653035",
            "telephone_number": "601-544-7404",
            "fax_number": "601-584-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLESPIE",
        "first_name": "GEORGE",
        "name_suffix": "III",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "19284",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "19284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSPRING",
            "identifier": "6039505",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9864055",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0029455",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05020034",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petal, MS

Sources for this page

Verify at the official NPI Registry.