Amaris Medical Group, LLC
Organization Active NPI Nurse Practitioner · Kosciusko, MS
NPI 1285256271 · NPPES record last updated Aug 5, 2025
Key facts
- NPI
- 1285256271
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- AMARIS MEDICAL GROUP, LLC
- Practice address
- 308 N Jackson St
Kosciusko, MS 39090-3322 - Phone
- (662) 582-1925
- NPI assigned
- May 12, 2020
- Organization subpart
- No
Authorized official
- Name
- Ms. Anita Greer, NP
- Title
- Ceo
- Phone
- (662) 582-1925
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2209251 | Amaris Medical Group | Provider-performed microscopy | Jan 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201230001269 | MS | Part B Supplier - Clinic/Group Practice | 0749693273 |
Receives reassigned benefits from 1 practitioner Practice locations: Kosciusko, MS |
National Provider Directory
Locations
308 N Jackson St
Kosciusko, MS 39090
Phone (662) 582-1925
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
308 N Jackson St
Kosciusko, MS 39090-3322
Mailing address
PO Box 372
Kosciusko, MS 39090-0372
Phone (662) 582-1925
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780087304 | Other | MS | IND NPI |
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All providers in Kosciusko, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.