Riverbend Healthcare PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

RIVERBEND HEALTHCARE PLLC

Practice address

2011 Hwy 61 N
Vicksburg, MS 39183

Phone

(601) 456-2277

NPI assigned

Jul 29, 2021

Organization subpart

No

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

Authorized official

Name

Manivanh A Prudhomme, FNP

Title

Ceo

Phone

(601) 456-2277

Specialties & licenses 2

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24012/brand/1/csg/1/fhir/r4

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jon Bantugan, OD

  • Optometrist
  • Vicksburg, MS
  • NPI 1346169299
  NPD
• Hilary Melby Parrish, O.D.

  • Optometrist
  • Vicksburg, MS
  • NPI 1811242357
  NPD
• Eli B Lemonier, O.D.

  • Optometrist
  • Springfield, MO
  • NPI 1013105022
  NPD (past)

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1417620071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29841",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049152050",
            "telephone_number": "601-456-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 HWY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39183",
            "telephone_number": "601-456-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERBEND HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-29",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "PRUDHOMME",
        "authorized_official_first_name": "MANIVANH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-456-2277",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• River Oaks Management Company, LLC
• River Physicians Group, LLC
• River Region Health System
• River Region Health System
• Riverbend Eyecare, P.a.
• Riverview Behavior Health Services
• Rlgmdpa Inc
• Gregory Scott Robbins, PT, DPT
• Robert a. Sadler DDS, PA
• Robert C Masterson DO PA Inc

• Clinic/Center in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.