East Mississippi Medical Clinic
Organization Active NPI Primary Care Clinic/Center · Newton, MS
NPI 1497096036 · NPPES record last updated Jun 24, 2013
Key facts
- NPI
- 1497096036
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 14494 (MS)
- Legal business name
- EAST MISSISSIPPI MEDICAL CLINIC
- Practice address
- 9425 Eastside Drive Ext
Suit a
Newton, MS 39345-8068 - Phone
- (601) 635-3333
- Fax
- (601) 653-3330
- NPI assigned
- Mar 6, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Razee Ameir Ahmad, M.D.
- Title
- Owner
- Phone
- (601) 917-0810
Other NPIs on the same Medicare enrollment 1
Practitioners 11
-
Courtney Anita Hampton Bennett, APMHNP-BC
-
Courtney S Dubose, FNP-BC
-
Jenna Harper, AGPCNP-BC
-
Kymberleigh James, FNP-BC
-
Priscilla Miller, FNP
-
Farhan Nafis, MD
-
Kerry M Scott, D.O.
-
Dawn Holley Kiker, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060602000226 | MS | Part B Supplier - Clinic/Group Practice | 1456362557 |
Receives reassigned benefits from 10 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Meridian, MS |
National Provider Directory
Locations
9425 Eastside Drive Ext
Ste A
Newton, MS 39345
Phone (601) 635-3333
Interoperability endpoints
- https://api.platform.athenahealth.com/22967/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 14494 | MS | Yes |
Addresses
Primary practice location
9425 Eastside Drive Ext
Suit a
Newton, MS 39345-8068
Mailing address
PO Box 3189
Meridian, MS 39303-3189
Phone (601) 635-3333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04278332 | Medicaid | MS |
Other providers in Newton, MS
- Alana Douglas
- Tricia Driggers
- East Central Mississippi Health Care, Inc.
- East Central Planning & Development District
- East Central Planning and Development District
- East Mississippi Medical Clinic, PLLC
- East Mississippi State Hospital
- Rebecca Elon Everett Espey
- Leslie Kevin Ethridge
- Fast Pace Mississippi, PLLC
All providers in Newton, MS · Primary Care Clinic/Center in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.