NPIMap

Individual provider Active NPI

George Abraham, MD

  • Family Medicine Physician
  • Vicksburg, MS
National Provider Identifier
1184669798
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
07276 Issued in MS
Practice address
1907 Mission 66
Vicksburg, MS 39180-3711
Phone
(601) 619-3838
NPI assigned
Jun 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 07276 MS Primary

Addresses

Primary practice location

1907 Mission 66
Vicksburg, MS 39180-3711

Mailing address

1907 Mission 66
Vicksburg, MS 39180-3711
Phone (601) 619-3838

Other identifiers 3

IdentifierTypeStateIssuer
0114239MedicaidMS
1189677MedicaidLA
4578402OtherMSAETNA

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
I20040715000907 MS Practitioner - Family Practice 5294636734 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yalobusha General Hospital 19 clinicians

Practice addresses (Care Compare)

604 S Main St
Odom Rural Health Clinic
Water Valley, MS 38965-3468
Phone (662) 473-4050

Hospital & facility affiliations

  • Accentcare Home Health of Greenwood Home health agency, Greenwood, MS, CCN 257131
  • Baptist Home Care and Hospice North Mississippi Home health agency, Batesville, MS, CCN 257114
  • Centerwell Home Health Home health agency, Bruce, MS, CCN 257309
  • Accentcare Hospice & Palliative Care of Ms Hospice, Flowood, MS, CCN 251511
  • Yalobusha General Hospital Hospital, Water Valley, MS, CCN 250061
  • Baptist Memorial Hospital North Ms Hospital, Oxford, MS, CCN 250034
  • Yalobusha General Hospital Nursing home, CCN 25U061

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Yalobusha General Hospital Current Accepting new patients
Yalobusha General Hospital Past Accepting new patients
Yalobusha County Nursing Home Dba Yalobusha General Hospital Past Accepting new patients
Vicksburg Clinic LLC Family Medicine Past Accepting new patients
Yalobusha General Hospital Past Accepting new patients

Locations

604 S Main St
Water Valley, MS 38965
Phone (662) 473-1311

Interoperability endpoints

  • Direct secure messaging: george.abraham.1@15461.direct.athenahealth.com

Organizations & group practices 8

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.

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225152000000",
    "number": "1184669798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1907 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-619-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-619-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABRAHAM",
        "first_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2008-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "07276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0114239",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1189677",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4578402",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

Verify at the official NPI Registry.