Rolling Fork Medical Clinic, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ROLLING FORK MEDICAL CLINIC, LLC

Practice address

44 S Fourth St
Rolling Fork, MS 39159-5147

Phone

(662) 335-4105

Fax

(662) 378-2879

NPI assigned

Oct 3, 2019

Last updated

Oct 3, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Thomas Hearn

Title

Manager

Phone

(662) 335-4105

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Interoperability endpoints

• Direct secure messaging: lisa@deltakidney.com

Practitioners 1

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.

• Wilson M Parry, MD

  • Nephrology Physician
  • Greenville, MS
  • NPI 1124188347
  NPD (past)

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1275174971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1997 MEDICAL PARK DR",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037268",
            "telephone_number": "662-335-4105",
            "fax_number": "662-335-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 S FOURTH ST",
            "city": "ROLLING FORK",
            "state": "MS",
            "postal_code": "391595147",
            "telephone_number": "662-335-4105",
            "fax_number": "662-378-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLLING FORK MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "HEARN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "662-335-4105"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05457590",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lisa@deltakidney.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "44 S Fourth St",
            "city": "Rolling Fork",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391595147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Casey Cummins Perry, PHARM. D.
• RCG of Mayersville, LLC
• Rolling Fork Drug Co (Rolling Fork Drug Company LTC)
• Rolling Fork Drug Co
• Rolling Fork Eye Clinic
• Sharkey Issaquena Comm Hosp - Ekg
• Sharkey Issaquena Comm Hosp-Ambulance
• Sharkey Issaquena Comm Hosp-ER
• Sharkey Issaquena Comm Hospital - Radiology
• Sharkey Issaquena Community Hospital

• Family Medicine Physician in Rolling Fork, MS
• Providers in Rolling Fork, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.