Individual provider Active NPI

Diane A Ferguson, MD

  • Family Medicine Physician
  • Horn Lake, MS
National Provider Identifier
1265525331
Registry record updated May 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10806 Issued in MS
Practice address
2085 Goodman Rd W
Suite 50
Horn Lake, MS 38637-1416
Phone
(662) 253-8459
Fax
(662) 253-8678
NPI assigned
Oct 2, 2006
Last updated
May 4, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2016

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 10806 MS Primary

Addresses

Primary practice location

2085 Goodman Rd W
Suite 50
Horn Lake, MS 38637-1416

Mailing address

2085 Goodman Rd W
Suite 50
Horn Lake, MS 38637-1416
Phone (662) 253-8459

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
I20081003000687 MS Practitioner - Family Practice 1850469867 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sandk Medical,LLCGroup PAC ID 0446578660, 2 clinicians

Practice addresses (Care Compare)

2085 Goodman Rd W
Horn Lake, MS 38637-1416
Phone (662) 253-8459

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10806MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
S&K Medical,LLC Family Medicine CurrentSince Jan 1, 2016 Accepting new patients

Organizations & group practices 1

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 5

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462320000000",
    "number": "1265525331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 GOODMAN RD W",
            "address_2": "SUITE 50",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371416",
            "telephone_number": "662-253-8459",
            "fax_number": "662-253-8678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 GOODMAN RD W",
            "address_2": "SUITE 50",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371416",
            "telephone_number": "662-253-8459",
            "fax_number": "662-253-8678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "DIANE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2016-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "10806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Horn Lake, MS

Sources for this page

Verify at the official NPI Registry.