Individual provider Active NPI

Roy Russell Reeves, DO

  • Psychiatry Physician
  • Jackson, MS
National Provider Identifier
1477564664
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
17349 Issued in MS
Practice address
1500 E Woodrow Wilson Drive
VA Med Center - Psychiatry 11M
Jackson, MS 39216
Phone
(601) 368-4152
Fax
(601) 364-1395
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 17349 MS Primary

Addresses

Primary practice location

1500 E Woodrow Wilson Drive
VA Med Center - Psychiatry 11M
Jackson, MS 39216

Mailing address

1500 E Woodrow Wilson Drive
VA Med Center - Psychiatry 11M
Jackson, MS 39216
Phone (601) 368-4152

Other practice location 1

415 S 28th Ave
Hattiesburg, MS 39401-7246
Phone (601) 261-1750

Other identifiers 1

IdentifierTypeStateIssuer
04088365MedicaidMS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rreeves72029@directpatientrecord.com Health Information Exchange (HIE)

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
I20051212000648 MS Practitioner - Psychiatry 0749219814 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

1 Lincoln Pkwy
Hattiesburg, MS 39402-3261

415 S 28TH Ave
Hattiesburg, MS 39401-7246

415 S 28TH Ave 3Rd Floor
Ambulatory Cardiovascular Center of Mississ
Hattiesburg, MS 39401-7246
Phone (601) 268-1734

415 S 28TH Ave FL
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17349MSMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic PA CurrentSince Apr 30, 2018 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Hattiesburg Clinic, PA CurrentSince Apr 30, 2018 Accepting new patients

Locations

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

4555 Highland Park Dr
Meridian, MS 39307
Phone (601) 482-6186

305 W Moody St
Poplarville, MS 39470
Phone (601) 795-4345

823 Highway 589
Purvis, MS 39475
Phone (601) 794-0100

Interoperability endpoints

  • Direct secure messaging: rreeves72029@directpatientrecord.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1477564664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON DRIVE",
            "address_2": "VA MED CENTER - PSYCHIATRY 11M",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-368-4152",
            "fax_number": "601-364-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON DRIVE",
            "address_2": "VA MED CENTER - PSYCHIATRY 11M",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-368-4152",
            "fax_number": "601-364-1395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 S 28th Ave",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394017246",
            "country_code": "US",
            "telephone_number": "601-261-1750",
            "fax_number": "601-579-5240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REEVES",
        "first_name": "ROY",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "17349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04088365",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rreeves72029@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "415 S 28th Ave",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394017246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.