Marcus Lydell Harris, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT2696 Issued in MS

Practice address

711 Avignon Dr
Ridgeland, MS 39157-5120

Phone

(601) 605-6777

Fax

(601) 607-1553

NPI assigned

Jan 28, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Elite Performance and Rehab, LLC

  • Physical Therapy Clinic/Center
  • Vicksburg, MS
  • NPI 1255877346

  MS

  Medicare reassignment Care Compare group NPD
• Diagnostic Testing Solutions

  • Physiological Laboratory
  • Vicksburg, MS
  • NPI 1154746154
  NPD (past)
• Good Samaritan Physical Therapy,Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Vicksburg, MS
  • NPI 1023087855
  NPD (past)

Specialty

Occupational Therapist in Private Practice

Education

University of Mississippi School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Performance and Rehab, LLC 5 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359331200000",
    "number": "1508104472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 AVIGNON DR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391575120",
            "telephone_number": "601-605-6777",
            "fax_number": "601-607-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 AVIGNON DR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391575120",
            "telephone_number": "601-605-6777",
            "fax_number": "601-607-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "MARCUS",
        "middle_name": "LYDELL",
        "name_prefix": "Mr.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-28",
        "last_updated": "2013-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MS",
            "license": "OT2696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janice Sue Harmon, PSY.D.
• Jillian Harney, M.S., CCC-SLP
• Harris Medical Supply Group, LLC
• Amber Harris
• Faith Harris, DPT
• Morgan Henley Harris, LPC-S, RPT, BC-TMH
• Sherry Louise Harris, LPTA
• Emily Harrison, OT
• Chad Michael Hartley, DMD
• Abigail Kelsey Hartman, OT

• All providers in Ridgeland, MS
• Occupational Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.