Active NPI
Michael Ray Lewis, M.D.
- Specialist
- Gulfport, MS
National Provider Identifier
1568409878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 13326
- Practice address
- 4500 Old Pass Rd
Gulfport, MS 39501-2585 - Phone
- (228) 865-7890
- Fax
- (228) 868-7402
- NPI assigned
- Jun 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 13326 | MS | Primary |
Addresses
Primary practice location
4500 Old Pass Rd
Gulfport, MS 39501-2585
Mailing address
4500 Old Pass Rd
Gulfport, MS 39501-2585
Phone (228) 865-7890
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060065909 | Other | MS | MEDICARE SECONDARY PAYOR |
| 00116618 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 31, 2015 through Dec 31, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital at Gulfport | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Gulfport, MS
- NPI 1962780379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256688000000",
"number": "1568409878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 OLD PASS RD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395012585",
"telephone_number": "228-865-7890",
"fax_number": "228-868-7402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 OLD PASS RD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395012585",
"telephone_number": "228-865-7890",
"fax_number": "228-868-7402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "MICHAEL",
"middle_name": "RAY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2009-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MS",
"license": "13326",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE SECONDARY PAYOR",
"identifier": "060065909",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00116618",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.