NPIMap

Organization Active NPI

Relias Emergency Medicine Specialists of McComb, LLC

  • Emergency Medicine Physician
  • McComb, MS
National Provider Identifier
1477195972
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
RELIAS EMERGENCY MEDICINE SPECIALISTS OF MCCOMB, LLC
Practice address
215 Marion Ave
McComb, MS 39648-2705
Phone
(662) 432-4106
NPI assigned
Oct 16, 2019
Last updated
Jul 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

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

Authorized official

Name
Mr. Luke West
Title
Ceo
Phone
(662) 635-8383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

215 Marion Ave
McComb, MS 39648-2705

Mailing address

8 Oak Park Dr
Bedford, MA 01730-1414
Phone (662) 432-4106

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200107000381 MS Part B Supplier - Clinic/Group Practice 7517391121 Receives reassigned benefits from 35 practitioners
Practice locations: McComb, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1571184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594944000000",
    "number": "1477195972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 OAK PARK DR",
            "city": "BEDFORD",
            "state": "MA",
            "postal_code": "017301414",
            "telephone_number": "662-432-4106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482705",
            "telephone_number": "662-432-4106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIAS EMERGENCY MEDICINE SPECIALISTS OF MCCOMB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-16",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-635-8383",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McComb, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.