Roger Dale Ridgeway Jr., M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

21922 Issued in MS

Practice address

4502 LT Eugene J Majure Dr
Pascagoula, MS 39581-5305

Phone

(228) 696-9224

Fax

(228) 696-9228

NPI assigned

Jun 19, 2008

Last updated

Oct 11, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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

Specialty

Psychiatry

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Singing River Health System Hospital, Pascagoula, MS, CCN 250040
• Singing River Gulfport Hospital, Gulfport, MS, CCN 250123

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rridgeway@landmarkhealth-direct.org

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.

• Singing River Health System

  • Multi-Specialty Clinic/Center
  • Gautier, MS
  • NPI 1083893937
  Medicare reassignment Care Compare group NPD
• Singing River Gulfport

  dba Singing River Gulfport Ambulatory

  • Multi-Specialty Clinic/Center
  • Gulfport, MS
  • NPI 1861010159
  Medicare reassignment NPD
• Singing River Gulfport

  • Internal Medicine Physician
  • Gulfport, MS
  • NPI 1487327193
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Singing River Gulfport

  • General Acute Care Hospital
  • Gulfport, MS
  • NPI 1639797913
  Care Compare affiliation
• Singing River Health System

  • Multi-Specialty Clinic/Center
  • Gautier, MS
  • NPI 1083893937

  Hospital

  Care Compare affiliation
• Singing River Health System

  • General Acute Care Hospital
  • Pascagoula, MS
  • NPI 1124136593
  Care Compare affiliation

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1427219799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535340",
            "telephone_number": "228-497-7584",
            "fax_number": "228-497-7586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 LT EUGENE J MAJURE DR",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815305",
            "telephone_number": "228-696-9224",
            "fax_number": "228-696-9228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14116 Customs Blvd",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "395035164",
            "country_code": "US",
            "telephone_number": "833-362-6703",
            "fax_number": "855-362-0778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDGEWAY",
        "first_name": "ROGER",
        "middle_name": "DALE",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-19",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AL",
            "license": "31130",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "21922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02030025",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Pascagoula, MS
• Providers in Pascagoula, MS by specialty
• Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.