Individual provider Active NPI

Carey Martin, LCSW

  • Clinical Social Worker
  • Vicksburg, MS
National Provider Identifier
1396487112
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C8050 Issued in MS
Practice address
1911 Mission 66 Ste B
Vicksburg, MS 39180-3762
Phone
(601) 665-4162
Fax
(855) 830-3484
NPI assigned
Apr 12, 2022
Last updated
Apr 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C8050 MS Primary

Addresses

Primary practice location

1911 Mission 66 Ste B
Vicksburg, MS 39180-3762

Mailing address

557 Grants Ferry Rd
Brandon, MS 39047-9023
Phone (601) 665-4162

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, LA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240426000352 MS Practitioner - Clinical Social Worker 9234579004 Reassigns benefits to 2 organizations
I20260501002949 LA Practitioner - Clinical Social Worker 9234579004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uppal Medical Center LLCGroup PAC ID 4587998547, 129 clinicians
MDB Behavioral Health Services LLCGroup PAC ID 0749572915, 201 clinicians

Practice addresses (Care Compare)

1727 E Union St
Greenville, MS 38703-3253
Phone (662) 537-4830

1911 Mission
Vicksburg, MS 39180-3762
Phone (601) 456-2598

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C8050MSMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Minor Med Care, LLC CurrentSince Jan 21, 2026 Accepting new patients
Uppal Medical Center LLC CurrentSince Aug 1, 2026 Accepting new patients
Minor Med Care, LLC CurrentSince Jan 21, 2026 Accepting new patients
MDB Behavioral Health Services LLC CurrentSince Apr 1, 2024 Accepting new patients

Locations

557 Grants Ferry Rd
Brandon, MS 39047
Phone (601) 207-2017

1727 E Union St
Greenville, MS 38703
Phone (662) 332-0373

215 Katherine Dr
#A
Jackson, MS 39232

2860 McDowell Road Ext
Jackson, MS 39204
Phone (601) 372-1117

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649721600000",
    "number": "1396487112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 GRANTS FERRY RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390479023",
            "telephone_number": "601-665-4162",
            "fax_number": "855-830-3484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 MISSION 66 STE B",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803762",
            "telephone_number": "601-665-4162",
            "fax_number": "855-830-3484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CAREY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C8050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

Verify at the official NPI Registry.