Canon Jade Beissel, MD
Individual provider Active NPI Nephrology Physician · Grenada, MS
NPI 1154483394 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1154483394
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- 16518 (MS)
- Practice address
- 35 W Monroe St
Grenada, MS 38901-5222 - Phone
- (662) 226-8229
- Fax
- (662) 226-3300
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 36
Hospital & facility affiliations 10
Medicare Care Compare profile
- Specialty
- Nephrology
- Education
- University of Mississippi School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tallahatchie General Hospital
Delta Hills Nephrology Clinics PLLC
Delta Hills Nephrology Associates
Grenada Physician Services, LLC
State of Mississippi - University of Mississippi Medical Center
Practice addresses (Care Compare)
1301 Sunset Dr
Suite E
Grenada, MS 38901-4103
Phone (662) 625-7191
141 Dr T T Lewis Circle
Charleston, MS 38921-2236
Phone (662) 647-5392
35 W Monroe St
Grenada, MS 38901-5222
Phone (662) 226-5112
609 Tallahatchie St
Greenwood, MS 38930-2005
Phone (601) 453-5208
960 Avent Dr
Grenada, MS 38901-5230
Phone (662) 227-7000
965 Avent Dr
Grenada, MS 38901-5045
Phone (662) 227-7444
Hospital & facility affiliations
- RCG Winona
- RCG Grenada
- DaVita Renal Care of Lexington
- University of Mississippi Medical Center- Grenada
- Greenwood Leflore Hospital
- Tallahatchie General Hospital-Cah
- Tyler Holmes Memorial Hospital Cah
- Holmes County Hospital and Clinics
- Tallahatchie General Hospital-Cah
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- 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 |
|---|---|---|---|---|
| I20080617000689 | MS | Practitioner - Nephrology |
3274604376 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16518 | MS | MD | Nephrology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Delta Hills Nephrology Associates | Nephrology | Current |
Accepting 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 | |
| Grenada Physician Services, LLC | Current |
Accepting 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 | |
| Tallahatchie General Hospital | Current |
Accepting new patients | |
| Delta Hills Nephrology Clinics PLLC | Nephrology | Current |
Accepting new patients |
| Tallahatchie General Hospital | Current |
Accepting new patients | |
| Tallahatchie General Hospital | Current |
Accepting new patients | |
| State of Mississippi-University of Mississippi Medical Center | Past | Accepting new patients | |
| University Physicians, PLLC | Past | Accepting new patients |
Locations
609 Tallahatchie St
Greenwood, MS 38930
Phone (601) 453-5208
35 W Monroe St
Grenada, MS 38901
Phone (662) 226-5112
33 W Monroe St
Grenada, MS 38901
960 Avent Dr
Grenada, MS 38901
Phone (662) 227-7000
960 Avent Dr
Ste 102
Grenada, MS 38901
Phone (662) 227-7492
1301 Sunset Dr
Ste E
Grenada, MS 38901
Phone (662) 229-0069
965 Avent Dr
Ste 100A
Grenada, MS 38901
Phone (662) 227-7000
239 Bowling Green Rd
Lexington, MS 39095
Phone (662) 834-1321
Interoperability endpoints
- bolv_-_dr._canon_beissel_physician@yourcarecommunity.org
- canon.beissel@scs-direct.glh.org
- cbeissel22261@ummc.direct-ci.com
- canon.beissel.1@29589.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 16518 | MS | Yes |
Addresses
Primary practice location
35 W Monroe St
Grenada, MS 38901-5222
Mailing address
PO Box 1041
Grenada, MS 38902-1041
Phone (662) 226-9866
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06050013 | Medicaid | MS |
Other providers in Grenada, MS
- Kristina Ballard
- David Ray Basinger Jr.
- Sylvia C Bass
- Tracey Baxter
- Katrina L Bays
- Morgan Claire Rose Bell
- Jason K Bennett
- Nora Bishop
- Raven Celeste Boatman
- Sidney Bondurant
All providers in Grenada, MS · Nephrology 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 Jul 9, 2007. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.