Douglas Porter Anderson, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

101 Cunningham Dr
Ripley, MS 38663-1302

Phone

(662) 837-3011

NPI assigned

Jan 23, 2017

Last updated

Nov 12, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mr. Douglas Porter Anderson Other name

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

Merit-based Incentive Payment System (MIPS)

Final score

18 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

59.99

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Wilco Healthcare of North Mississippi, PLLC

  • Family Medicine Physician
  • Tupelo, MS
  • NPI 1821556838
  Medicare reassignment Authorized official
• Chris Park DO PC

  dba Park Medical Clinic

  • Family Medicine Physician
  • Pontotoc, MS
  • NPI 1831710623
  Medicare reassignment
• Ostranderson Medical PLLC

  dba Bespoke Medical

  • Addiction Medicine (Family Medicine) Physician
  • Oxford, MS
  • NPI 1639828981
  NPD

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

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1235676792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4637 WHITECHAPEL LN",
            "city": "BELDEN",
            "state": "MS",
            "postal_code": "388269780",
            "telephone_number": "662-255-2163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CUNNINGHAM DR",
            "city": "RIPLEY",
            "state": "MS",
            "postal_code": "386631302",
            "telephone_number": "662-837-3011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 Earl Frye Blvd",
            "address_purpose": "LOCATION",
            "city": "Amory",
            "state": "MS",
            "postal_code": "388215509",
            "country_code": "US",
            "telephone_number": "662-256-9344",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "118 S Glenfield Rd",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "MS",
            "postal_code": "386522605",
            "country_code": "US",
            "telephone_number": "662-534-9506",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2273 S Eason Blvd",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388045900",
            "country_code": "US",
            "telephone_number": "662-842-2461",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Long St",
            "address_purpose": "LOCATION",
            "city": "Booneville",
            "state": "MS",
            "postal_code": "388294306",
            "country_code": "US",
            "telephone_number": "662-728-5625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "907 E Walker St",
            "address_purpose": "LOCATION",
            "city": "Fulton",
            "state": "MS",
            "postal_code": "388438954",
            "country_code": "US",
            "telephone_number": "662-862-6140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 Briar Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388045903",
            "country_code": "US",
            "telephone_number": "662-844-0675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1122 North Eshman Avenue",
            "address_purpose": "LOCATION",
            "city": "West Point",
            "state": "MS",
            "postal_code": "39773",
            "country_code": "US",
            "telephone_number": "662-494-6011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "DOUGLAS",
        "middle_name": "PORTER",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-23",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03482206",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOUGLAS",
            "last_name": "ANDERSON",
            "middle_name": "PORTER",
            "prefix": "MR.",
            "credential": "P.A.-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Micah Brooke Akins, DNP, FNP-C, ENP-C
• Angelia Allen, MSW
• Angel Hospice, LLC
• Athletico, LTD (Athletico Physical Therapy)
• Elizabeth Davis Bailey, LMSW
• Monica Ballard, O.D.
• Linda Barkley, PCMHT

• Physician Assistant in Ripley, MS
• Providers in Ripley, MS by specialty
• Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.