Active NPI
Amita Maibam, M.D.
- Nephrology Physician
- Tupelo, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 26530
- Practice address
- 1542 Medical Park Cir
Tupelo, MS 38801-6560 - Phone
- (662) 844-4711
- Fax
- (662) 844-9619
- NPI assigned
- Aug 19, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 26530 | MS | Primary |
Addresses
Primary practice location
1542 Medical Park Cir
Tupelo, MS 38801-6560
Mailing address
1542 Medical Park Cir
Tupelo, MS 38801-6560
Phone (662) 844-4711
Other practice location 1
University Of Kentucky 800 Rose St
Lexington, KY 40536-0293
Phone (859) 323-2636
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1542 Medical Park Cir
Tupelo, MS 38801-6560
Phone (662) 844-4711
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26530 | MS | MD | Nephrology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nephrology & Hypertension Associates, LTD. | Single Specialty | Current | Accepting new patients |
| North Mississippi Medical Center | Current | Accepting new patients |
Locations
3301 Tinin Dr
Corinth, MS 38834
Phone (662) 665-9111
1542 Medical Park Cir
Tupelo, MS 38801
Phone (662) 680-9610
Interoperability endpoints
- amitamaibam@nmhs.medalliesdirect.net
- https://fhir4.healow.com/fhir/r4/JADIBA
- amaibam30308@direct.acumenmd.com
Organizations & group practices 2
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.
-
- Nephrology Physician
- Tupelo, MS
- NPI 1902975139
Single Specialty
-
- General Acute Care Hospital
- Tupelo, MS
- NPI 1376969683
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Renal Care Group Tupelo
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Tupelo, MS
- NPI 1740382126
Dialysis facility
-
dba Tupelo Home Therapies
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Tupelo, MS
- NPI 1972971679
Dialysis facility
-
dba North Mississippi Medical Center - Gilmore - Amory
- General Acute Care Hospital
- Amory, MS
- NPI 1164993457
-
dba North Ms Rehab Unit
- Rehabilitation Hospital Unit
- Tupelo, MS
- NPI 1326155706
Inpatient rehabilitation facility
-
dba North Mississippi Medical Center
- General Acute Care Hospital
- Tupelo, MS
- NPI 1598875460
-
dba Pontotoc Health Services CAH
- Critical Access Hospital
- Pontotoc, MS
- NPI 1821103516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565568000000",
"number": "1487020806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1542 MEDICAL PARK CIR",
"city": "TUPELO",
"state": "MS",
"postal_code": "388016560",
"telephone_number": "662-844-4711",
"fax_number": "662-844-9619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1542 MEDICAL PARK CIR",
"city": "TUPELO",
"state": "MS",
"postal_code": "388016560",
"telephone_number": "662-844-4711",
"fax_number": "662-844-9619"
}
],
"practiceLocations": [
{
"address_1": "University Of Kentucky 800 Rose St",
"address_purpose": "LOCATION",
"city": "Lexington",
"state": "KY",
"postal_code": "405360293",
"country_code": "US",
"telephone_number": "859-323-2636",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAIBAM",
"first_name": "AMITA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-19",
"last_updated": "2019-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": "MS",
"license": "26530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; 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.