NPIMap

Individual provider Active NPI

David McCaa Headley, MD

  • Family Medicine Physician
  • Port Gibson, MS
National Provider Identifier
1528032406
Registry record updated Apr 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
09133 Issued in MS
Practice address
405 Market St
Port Gibson, MS 39150
Phone
(601) 437-3323
Fax
(601) 437-8499
NPI assigned
Feb 15, 2006
Last updated
Apr 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 09133 MS Primary

Addresses

Primary practice location

405 Market St
Port Gibson, MS 39150

Mailing address

PO Box 676
Port Gibson, MS 39150
Phone (601) 437-3323

Other identifiers 2

IdentifierTypeStateIssuer
1528032406OtherMSRAILROAD MEDICARE
00013805MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110408000130 MS Practitioner - Family Practice 8729088281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
David M. Headley, M.D. PAGroup PAC ID 6002816568, 2 clinicians

Practice addresses (Care Compare)

405 Market St
Port Gibson, MS 39150-2024
Phone (601) 437-3113

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions13
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
David M. Headley, M.D. PA Family Medicine CurrentSince Mar 9, 2012 Accepting new patients
Claiborne County Senior Care LLC Past Accepting new patients
Claiborne County Hospital Past Accepting new patients
Housecall Practitioners Inc. Past Accepting new patients

Locations

123 McComb Ave
Port Gibson, MS 39150
Phone (601) 437-5141

405 Market St
Port Gibson, MS 39150
Phone (601) 437-3113

Organizations & group practices 4

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333411200000",
    "number": "1528032406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 676",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "39150",
            "telephone_number": "601-437-3323",
            "fax_number": "601-437-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 MARKET ST",
            "city": "PORT GIBSON",
            "state": "MS",
            "postal_code": "39150",
            "telephone_number": "601-437-3323",
            "fax_number": "601-437-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEADLEY",
        "first_name": "DAVID",
        "middle_name": "MCCAA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2012-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "09133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "1528032406",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00013805",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Gibson, MS

Sources for this page

Verify at the official NPI Registry.