NPIMap

Organization Active NPI

Cassidy Bayou Medical Clinic

  • Family Medicine Physician
  • Sumner, MS
National Provider Identifier
1376181990
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CASSIDY BAYOU MEDICAL CLINIC
Practice address
2372 US 49-E
Sumner, MS 38957
Phone
(662) 375-9310
NPI assigned
Dec 13, 2019
Last updated
Apr 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Authorized official

Name
Sonja Bush Pennington, FNPNPI 1386180610
Title
Provider/Owner
Phone
(662) 375-2363

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

2372 US 49-E
Sumner, MS 38957

Mailing address

PO Box 240
Sumner, MS 38957-0240
Phone (662) 375-9310

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200204000808 MS Part B Supplier - Clinic/Group Practice 4981030319 Receives reassigned benefits from 1 practitioner
Practice locations: Sumner, MS

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2052350Cassidy Bayou Medical Clinic2372 US-49 E, Sumner, MS 38957Certificate of waiverJan 8, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1576195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1376181990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 240",
            "city": "SUMNER",
            "state": "MS",
            "postal_code": "389570240",
            "telephone_number": "662-375-9310",
            "fax_number": "662-375-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2372 US 49-E",
            "city": "SUMNER",
            "state": "MS",
            "postal_code": "38957",
            "telephone_number": "662-375-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASSIDY BAYOU MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-13",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "SONJA",
        "authorized_official_middle_name": "BUSH",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "662-375-2363",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumner, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; 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.