Advanced Vascular and Vein Associates, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

ADVANCED VASCULAR AND VEIN ASSOCIATES, LLC

Practice address

4436 Mangum Dr
Flowood, MS 39232-2113

Phone

(601) 586-7070

Fax

(601) 586-7071

NPI assigned

Oct 1, 2021

Last updated

Oct 23, 2024By 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

Lachelle Griffin

Title

Credentialing Manager

Phone

(769) 208-4437

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 13

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.

• Carli Crapps, NP

  • Family Health Clinical Nurse Specialist
  • Flowood, MS
  • NPI 1134523111
  Medicare reassignment Care Compare group NPD
• Kelsi Feduccia, NP

  • Nurse Practitioner
  • Jackson, MS
  • NPI 1861195422
  Medicare reassignment Care Compare group NPD
• Danon Eugenio Garrido Montes de Oca, MD

  • Vascular Surgery Physician
  • Flowood, MS
  • NPI 1245545383
  Medicare reassignment Care Compare group NPD
• Justin Dale Manley, M.D.

  • Vascular Surgery Physician
  • Mobile, AL
  • NPI 1871780544

  MS

  Medicare reassignment Care Compare group NPD
• Abdul G Bahro, MD

  • Interventional Cardiology Physician
  • Flowood, MS
  • NPI 1447286612
  Medicare reassignment NPD
• Grace Fairley Hampton, MSN,APRN,FNP-C,CPN

  • Family Nurse Practitioner
  • Flowood, MS
  • NPI 1639634751
  Medicare reassignment NPD
• Rishi Ashok Roy, M.D.

  • Vascular Surgery Physician
  • Ocean Springs, MS
  • NPI 1215249016
  Medicare reassignment NPD
• Jennifer Sears

  • Acute Care Nurse Practitioner
  • Flowood, MS
  • NPI 1790487718
  Medicare reassignment NPD
• Michelle Nicole Moe-Aiken, M.D.

  • Vascular Surgery Physician
  • Keller, TX
  • NPI 1043672074

  MS

  Medicare reassignment NPD
• Rachel M Sellers, PA-C

  • Surgical Physician Assistant
  • Flowood, MS
  • NPI 1205466984
  Medicare reassignment
• Siera Cheyenne Shiyou, PA

  • Physician Assistant
  • Pascagoula, MS
  • NPI 1760956247
  Medicare reassignment
• Heather Hammons, PA-C

  • Physician Assistant
  • Ann Arbor, MI
  • NPI 1245827930

  MS

  Medicare reassignment

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1275205809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4436 MANGUM DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392322113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4436 MANGUM DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392322113",
            "telephone_number": "601-586-7070",
            "fax_number": "601-586-7071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED VASCULAR AND VEIN ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "LACHELLE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "769-208-4437"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Adam Adcock, M.D.
• Leslie Brannon Aden, M.D.
• Adl Solutions (The Back Clinic of Mississippi)
• Advance Medical Supplies, Inc.
• Advanced Foot Clinic PLLC
• Affordable Transportation Service LLC
• Agilitas USA, Inc (Results Physiotherapy)
• Robyn Agnew, PHARM.D.
• Mohit Ahuja, M.D.
• Jenna Marie Ainsworth, PA-C

• Multi-Specialty Clinic/Center in Flowood, MS
• Providers in Flowood, MS by specialty
• Multi-Specialty Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.