Individual provider Active NPI

Bobby Carlton Canton III, FNP-BC

  • Family Nurse Practitioner
  • McComb, MS
National Provider Identifier
1194497016
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
904925 Issued in MS
Practice address
215 Marion Ave
McComb, MS 39648-2705
Phone
(601) 249-5500
NPI assigned
Sep 29, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 904925 MS Primary

Addresses

Primary practice location

215 Marion Ave
McComb, MS 39648-2705

Mailing address

PO Box 490
McComb, MS 39649-0490
Phone (601) 250-4366

Other practice location 1

300 Rawls Dr Ste 200
McComb, MS 39648-2871
Phone (601) 249-1570

Other practice location 2

303 Marion Ave
McComb, MS 39648-2707
Phone (601) 249-1350

Other practice location 3

300 Rawls Dr Ste 600
McComb, MS 39648-2862
Phone (601) 249-4415

Other practice location 4

300 Rawls Dr Ste 700
McComb, MS 39648-2877
Phone (601) 250-4381

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220330000748 MS Practitioner - Nurse Practitioner 2466848528 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Mississippi Regional Medical CenterGroup PAC ID 5193633907, shared by 11 NPIs, 82 clinicians

Practice addresses (Care Compare)

215 Marion Ave
McComb, MS 39648-2705
Phone (601) 249-5500

Hospital & facility affiliations

  • Southwest Ms Regional Medical Center Hospital, McComb, MS, CCN 250097

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
904925MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Mississippi Regional Medical Center Current Accepting new patients
Southwest Mississippi Regional Medical Center CurrentSince Apr 1, 2022 Accepting new patients
Southwest Mississippi Regional Medical Center CurrentSince Apr 1, 2022 Accepting new patients
Southwest Mississippi Regional Medical Center CurrentSince Apr 1, 2022 Accepting new patients

Locations

300 Rawls Dr
Ste 600
McComb, MS 39648
Phone (601) 249-2701

215 Marion Ave
McComb, MS 39648
Phone (601) 249-1180

303 Marion Ave
McComb, MS 39648
Phone (601) 249-1350

300 Rawls Dr
Ste 700
McComb, MS 39648
Phone (601) 250-4381

300 Rawls Dr
Ste 200
McComb, MS 39648
Phone (601) 249-1570

Organizations & group practices 4

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 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": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1194497016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396490490",
            "telephone_number": "601-250-4366",
            "fax_number": "601-250-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482705",
            "telephone_number": "601-249-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Rawls Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "McComb",
            "state": "MS",
            "postal_code": "396482871",
            "country_code": "US",
            "telephone_number": "601-249-1570",
            "fax_number": "601-249-1544",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 Marion Ave",
            "address_purpose": "LOCATION",
            "city": "McComb",
            "state": "MS",
            "postal_code": "396482707",
            "country_code": "US",
            "telephone_number": "601-249-1350",
            "fax_number": "601-249-1339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Rawls Dr Ste 600",
            "address_purpose": "LOCATION",
            "city": "McComb",
            "state": "MS",
            "postal_code": "396482862",
            "country_code": "US",
            "telephone_number": "601-249-4415",
            "fax_number": "601-249-4474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Rawls Dr Ste 700",
            "address_purpose": "LOCATION",
            "city": "McComb",
            "state": "MS",
            "postal_code": "396482877",
            "country_code": "US",
            "telephone_number": "601-250-4381",
            "fax_number": "601-250-4382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANTON",
        "first_name": "BOBBY",
        "middle_name": "CARLTON",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-29",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McComb, MS

Sources for this page

Verify at the official NPI Registry.