NPIMap

Individual provider Active NPI

Mary Ellen Porter, NP

  • Nurse Practitioner
  • Flowood, MS
National Provider Identifier
1356489272
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP04559 Issued in LA
Practice address
1020 River Oaks Dr Ste 100
Flowood, MS 39232-9511
Phone
(601) 326-8700
Fax
(601) 932-4681
NPI assigned
Feb 2, 2007
Last updated
Sep 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP04559 LA Primary
Registered Nurse 163W00000X RN098282 LA

Addresses

Primary practice location

1020 River Oaks Dr Ste 100
Flowood, MS 39232-9511

Mailing address

1020 River Oaks Dr Ste 100
Flowood, MS 39232-9511
Phone (601) 326-8700

Other identifiers 1

IdentifierTypeStateIssuer
437505741BMedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mary.porter.1@4695.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170106000350 MS Practitioner - Nurse Practitioner 4688627631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7732 Old Canton Rd
Madison, MS 39110-9299
Phone (601) 856-1262

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.07 of 100Reported as apm
Quality
73.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN098282LAMDRegistered Nurse
AP04559LAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reservoir Family Medical Clinic, PA Current Accepting new patients
River Oaks Management Company CurrentSince Jan 1, 2024 Accepting new patients
River Oaks Management Company LLC Nurse Practitioner Current Accepting new patients
Careplus Lakeview Family Medicine CurrentSince Jan 1, 2024 Accepting new patients

Locations

1020 River Oaks Dr
Ste 100
Jackson, MS 39232
Phone (601) 326-8700

1030 River Oaks Dr
Jackson, MS 39232
Phone (601) 376-2165

7732 Old Canton Rd
Madison, MS 39110
Phone (601) 856-1262

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7115/brand/1/csg/1/fhir/r4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1356489272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 RIVER OAKS DR STE 100",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329511",
            "telephone_number": "601-326-8700",
            "fax_number": "601-932-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 RIVER OAKS DR STE 100",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329511",
            "telephone_number": "601-326-8700",
            "fax_number": "601-932-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "AP04559",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "LA",
            "license": "RN098282",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "437505741B",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mary.porter.1@4695.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1020 River Oaks Dr Ste 100",
            "city": "Flowood",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392329511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

Verify at the official NPI Registry.