Individual provider Active NPI

Ricardo Nimo, MD

  • Internal Medicine Physician
  • Centreville, MS
National Provider Identifier
1356395974
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
16415 Issued in MS
Practice address
270 E Main St
Centreville, MS 39631-4200
Phone
(601) 645-5361
NPI assigned
May 19, 2006
Last updated
Nov 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 16415 MS Primary

Addresses

Primary practice location

270 E Main St
Centreville, MS 39631-4200

Mailing address

178 Highway 24 E
Centreville, MS 39631-4171
Phone (601) 890-0520

Other identifiers 2

IdentifierTypeStateIssuer
1560201MedicaidLA
00121244MedicaidMS

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
I20100924000495 MS Practitioner - Internal Medicine 4789700956 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Natchez HB Medical Services LLCGroup PAC ID 8921461286, 30 clinicians

Practice addresses (Care Compare)

54 Sergeant Prentiss Dr
Natchez, MS 39120-4726
Phone (601) 443-2100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16415MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Field Memorial Community Hospital CurrentSince Feb 17, 2013 Accepting new patients
Natchez HB Medical Services LLC CurrentSince Jul 20, 2023 Accepting new patients
App of Mississippi Ed, LLC CurrentSince Mar 12, 2018 Accepting new patients

Locations

150 Reynoir St
Biloxi, MS 39530
Phone (228) 284-2389

350 Crossgates Blvd
Brandon, MS 39042
Phone (601) 824-8500

178 Highway 24 E
Ste A
Centreville, MS 39631
Phone (601) 645-5361

178 Highway 24 E
Ste B
Centreville, MS 39631
Phone (601) 835-0077

270 E Main St
Centreville, MS 39631
Phone 6016455221335

178 Highway 24 E
Centreville, MS 39631
Phone (601) 890-0500

1850 Chadwick Dr
Jackson, MS 39204
Phone (601) 376-1000

54 Sgt Prentiss Dr
Natchez, MS 39120
Phone (601) 443-2100

451 Bank St
Woodville, MS 39669
Phone (601) 888-3421

Organizations & group practices 3

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 1

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1356395974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 HIGHWAY 24 E",
            "city": "CENTREVILLE",
            "state": "MS",
            "postal_code": "396314171",
            "telephone_number": "601-890-0520",
            "fax_number": "601-645-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 E MAIN ST",
            "city": "CENTREVILLE",
            "state": "MS",
            "postal_code": "396314200",
            "telephone_number": "601-645-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIMO",
        "first_name": "RICARDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "16415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1560201",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00121244",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, MS

Sources for this page

Verify at the official NPI Registry.