NPIMap

Organization Active NPI

Urology Professional Association

Doing business as Urologic

  • Urology Physician
  • Tupelo, MS
National Provider Identifier
1508886805
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
UROLOGY PROFESSIONAL ASSOCIATION
Doing business as
Urologic
Practice address
499 Gloster Creek Village
Suite A1
Tupelo, MS 38801-4600
Phone
(662) 377-7118
Fax
(662) 377-7115
NPI assigned
Jul 20, 2006
Reactivated
Sep 21, 2023
Last updated
Jul 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
Gary Kyle Fallin
Title
Ceo
Phone
(662) 377-4092

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MS Primary

Addresses

Primary practice location

499 Gloster Creek Village
Suite A1
Tupelo, MS 38801-4600

Mailing address

499 Gloster Creek Village
Suite A1
Tupelo, MS 38801-4934
Phone (662) 377-7100

Other identifiers 1

IdentifierTypeStateIssuer
09011122MedicaidMS

Other names 1

  • Urologic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060906000564 MS Part B Supplier - Clinic/Group Practice 9335166834 Receives reassigned benefits from 15 practitioners
Practice locations: Corinth, MS; New Albany, MS; Tupelo, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0316976Urology Professional Association Dba Urologic499 Gloster Creek VLG Ste A1 - Lab Room 2, Tupelo, MS 38801ComplianceOct 16, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

971 Broad St
#4
Augusta, GA 30901
Phone (706) 434-2600

212 Alcorn Dr
Corinth, MS 38834
Phone (662) 287-9970

218 Oxford Rd
New Albany, MS 38652
Phone (662) 377-7100

499 Gloster Creek Vlg
Tupelo, MS 38801
Phone (662) 377-2663

499 Gloster Creek Vlg
Ste A1
Tupelo, MS 38801
Phone (662) 377-7100

100 Kestrel Dr
Ste C
Collegeville, PA 19426
Phone (610) 831-5354

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1508886805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VILLAGE",
            "address_2": "SUITE A1",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014934",
            "telephone_number": "662-377-7100",
            "fax_number": "662-377-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VILLAGE",
            "address_2": "SUITE A1",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014600",
            "telephone_number": "662-377-7118",
            "fax_number": "662-377-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY PROFESSIONAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "deactivation_date": "2023-09-13",
        "reactivation_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "FALLIN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-377-4092"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09011122",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urologic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 10, 2025; 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.