Individual provider Active NPI

Marvin Dunbar Jr., M.D.

  • Emergency Medicine Physician
  • Madison, MS
National Provider Identifier
1396794467
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
17276 Issued in MS
Practice address
104 Country Cove Lane
Madison, MS 39110-9755
Phone
(601) 856-1990
NPI assigned
May 8, 2006
Last updated
Feb 19, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 17276 MS Primary

Addresses

Primary practice location

104 Country Cove Lane
Madison, MS 39110-9755

Mailing address

104 Country Cove Lane
Madison, MS 39110-9755
Phone (601) 856-1990

Other identifiers 1

IdentifierTypeStateIssuer
00125232MedicaidMS

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
I20040323001044 MS Practitioner - Emergency Medicine 6204727811 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17276MSMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Clinics, Inc CurrentSince Mar 1, 2014 Accepting new patients
South Central Clinics, Inc CurrentSince Mar 1, 2014 Accepting new patients
Emergency Medicine Associates of Jackson Emergency Medicine Past Accepting new patients
St. Dominic Jackson Memorial Emergency Medicine Past Accepting new patients
Finest Emergency Physicians Emergency Medicine Past Accepting new patients
Lefleur Emergency Physicians Emergency Medicine Past Accepting new patients
Sterling Emergency Services of Mississippi, Inc Emergency Medicine Past Accepting new patients

Locations

701 S Holly Ave
Collins, MS 39428
Phone (601) 765-3180

1203 B Ave
Ellisville, MS 39437
Phone (601) 477-8553

1220 Jefferson St
Laurel, MS 39440
Phone (601) 426-4000

Interoperability endpoints

  • Direct secure messaging: mdunbar@direct.scrmc.com

Organizations & group practices 8

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": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203379200000",
    "number": "1396794467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 COUNTRY COVE LANE",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391109755",
            "telephone_number": "601-856-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 COUNTRY COVE LANE",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391109755",
            "telephone_number": "601-856-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNBAR",
        "first_name": "MARVIN",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2008-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "17276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125232",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

Verify at the official NPI Registry.