NPIMap

Individual provider Active NPI

Michael Brian Bagwell, D.O.

  • Family Medicine Physician
  • Senatobia, MS
National Provider Identifier
1558306019
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19146 Issued in MS
Practice address
2778 Highway 51 S
Senatobia, MS 38668-9403
Phone
(662) 560-5966
Fax
(662) 560-5969
NPI assigned
Jun 18, 2006
Last updated
Jul 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 19146 MS
Family Medicine Physician 207Q00000X 19146 MS Primary

Addresses

Primary practice location

2778 Highway 51 S
Senatobia, MS 38668-9403

Mailing address

2778 Highway 51 S
Senatobia, MS 38668-9403
Phone (662) 560-5966

Other identifiers 1

IdentifierTypeStateIssuer
08085016MedicaidMS

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
I20070108000237 MS Practitioner - Family Practice 2264432772 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2416 Mount Pleasant Rd
Hernando, MS 38632-2001
Phone (662) 560-5966

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Family Medical, LLC Current Accepting new patients
Tishomingo Health Services, Inc. Past Accepting new patients

Locations

4364 Highway 51 S
Senatobia, MS 38668
Phone (662) 560-5966

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17263/brand/1/csg/1/fhir/r4
  • Direct secure messaging: michael.bagwell.1@17263.direct.athenahealth.com

Organizations & group practices 3

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 9

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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1558306019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2778 HIGHWAY 51 S",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386689403",
            "telephone_number": "662-560-5966",
            "fax_number": "662-560-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2778 HIGHWAY 51 S",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386689403",
            "telephone_number": "662-560-5966",
            "fax_number": "662-560-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGWELL",
        "first_name": "MICHAEL",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "19146",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "19146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08085016",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Senatobia, MS

Sources for this page

Verify at the official NPI Registry.