NPIMap

Organization Active NPI

Midsouth Medicine

  • Internal Medicine Physician
  • Southaven, MS
National Provider Identifier
1194894147
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18647 Issued in MS
Legal business name
MIDSOUTH MEDICINE
Practice address
2149 Stateline Rd W
Southaven, MS 38671-1222
Phone
(662) 342-1112
Fax
(662) 342-1116
NPI assigned
Nov 6, 2006
Last updated
Apr 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Authorized official

Name
Dr. Ciao Zheng Newman, M.D., B.S., M.A.NPI 1922133206
Title
President
Phone
(662) 342-1112

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 18647 MS Primary

Addresses

Primary practice location

2149 Stateline Rd W
Southaven, MS 38671-1222

Mailing address

2149 Stateline Rd W
Southaven, MS 38671-1222
Phone (662) 342-1112

Other identifiers 1

IdentifierTypeStateIssuer
02207004MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040907000889 MS Part B Supplier - Clinic/Group Practice 3971579400 Receives reassigned benefits from 12 practitioners
Practice locations: Southaven, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1040419Midsouth Medicine, PC2149 Stateline Road West, Southaven, MS 38671Certificate of waiverMay 8, 2027

National Provider Directory

National Provider Directory

Locations

2149 Stateline Rd W
Southaven, MS 38671
Phone (662) 342-1112

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1194894147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 STATELINE RD W",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711222",
            "telephone_number": "662-342-1112",
            "fax_number": "662-342-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2149 STATELINE RD W",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711222",
            "telephone_number": "662-342-1112",
            "fax_number": "662-342-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSOUTH MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "CIAO",
        "authorized_official_middle_name": "ZHENG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-342-1112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., B.S., M.A."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "18647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02207004",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.