Individual provider Active NPI

Mary Gunn Prewitt, AU.D., CCC-A

  • Audiologist
  • Jackson, MS
National Provider Identifier
1306258553
Registry record updated Mar 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
A3929 Issued in MS
Practice address
2500 North State Street
Jackson, MS 39216-4500
Phone
(601) 815-3781
Fax
(601) 984-5085
NPI assigned
May 22, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X A3929 MS Primary

Addresses

Primary practice location

2500 North State Street
Jackson, MS 39216-4500

Mailing address

2500 North State Street
JMM Room 2525
Jackson, MS 39216-4500
Phone (601) 984-6426

Other identifiers 1

IdentifierTypeStateIssuer
02287740MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150420001618 MS Practitioner - Qualified Audiologist 3577782077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A3929MSMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 22, 2015 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 22, 2015 Accepting new patients
University Physicians, PLLC Past Accepting new patients
Desoto Thyroid and Endocrinology PastSince Sep 1, 2008 Accepting new patients

Locations

764 Lakeland Dr
Jackson, MS 39216
Phone (601) 982-0611

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

2500 N State St
Rm 2525
Jackson, MS 39216
Phone (601) 984-1530

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JFDIBD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522368000000",
    "number": "1306258553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "address_2": "JMM ROOM 2525",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-6426",
            "fax_number": "601-984-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-3781",
            "fax_number": "601-984-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREWITT",
        "first_name": "MARY GUNN",
        "name_prefix": "Dr.",
        "credential": "AU.D., CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-22",
        "last_updated": "2018-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MS",
            "license": "A3929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02287740",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; 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.