Individual provider Active NPI

Melissa B Roberts, MD

  • Emergency Medical Services (Emergency Medicine) Physician
  • Hattiesburg, MS
National Provider Identifier
1174517007
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
15983 Issued in MS
Practice address
2899 West 4TH Street
Hattiesburg, MS 39406
Phone
(601) 266-5370
Fax
(601) 266-4205
NPI assigned
Sep 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 15983 MS Primary

Addresses

Primary practice location

2899 West 4TH Street
Hattiesburg, MS 39406

Mailing address

118 College Drive Box 5066
Hattiesburg, MS 39406
Phone (601) 266-5390

Other identifiers 1

IdentifierTypeStateIssuer
00123317MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040310000914 MS Practitioner - Emergency Medicine 7618865551 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Mississippi School of Medicine, 1997
Medicare assignment
May accept Medicare assignment
Group practices
George Regional ER PhysiciansGroup PAC ID 6608180138, 10 clinicians

Practice addresses (Care Compare)

859 Winter St
Lucedale, MS 39452-6603
Phone (601) 947-1330

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15983MSMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
George County Hospital Current Accepting new patients
George County Hospital- Erp CurrentSince Apr 16, 2012 Accepting new patients
George County Hospital CurrentSince Apr 16, 2012 Accepting new patients
Community Medical Center Current Accepting new patients
Inpatient Physician Services CurrentSince Oct 1, 2021 Accepting new patients
George Regional ER Physicians Emergency Medical Services CurrentSince Jun 13, 2015 Accepting new patients
Pine Belt Anesthesia, LLC Past Accepting new patients
QHG of Hattiesburg Inc Emergency Medical Services Past Accepting new patients
The University of Southern Mississippi PastSince Oct 13, 2024 Accepting new patients

Locations

92 Ratliff St
#A
Lucedale, MS 39452
Phone (601) 947-4411

859 Winter St
Lucedale, MS 39452
Phone (601) 766-4286

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBHCBA

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 1

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": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1174517007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 COLLEGE DRIVE BOX 5066",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39406",
            "telephone_number": "601-266-5390",
            "fax_number": "601-266-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2899 WEST 4TH STREET",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39406",
            "telephone_number": "601-266-5370",
            "fax_number": "601-266-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MELISSA",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-07",
        "last_updated": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MS",
            "license": "15983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00123317",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.