Individual provider Active NPI

Megan Otto

  • Family Nurse Practitioner
  • Forest, MS
National Provider Identifier
1609323450
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
901717 Issued in MS
Practice address
330 N Broad St
Forest, MS 39074-3508
Phone
(601) 469-4151
Fax
(601) 469-3681
NPI assigned
Sep 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 901717 MS Primary

Addresses

Primary practice location

330 N Broad St
Forest, MS 39074-3508

Mailing address

330 N Broad St
Forest, MS 39074-3508
Phone (601) 469-4151

Other identifiers 1

IdentifierTypeStateIssuer
05531862MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161219001511 MS Practitioner - Nurse Practitioner 7012298607 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

347 S 4TH St
Morton, MS 39117-3407
Phone (601) 732-1524

Hospital & facility affiliations

  • Accentcare Home Health of Carthage Home health agency, Carthage, MS, CCN 257129
  • Mississippi Homecare of Jackson Home health agency, Jackson, MS, CCN 257082
  • S E Lackey Memorial Hospital Hospital, Forest, MS, CCN 251300
  • Ochsner Scott Regional Hospital, Morton, MS, CCN 251323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
901717MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Healthcare Management, Inc. CurrentSince Nov 15, 2016 Accepting new patients
Independent Healthcare Management, Inc. CurrentSince Nov 15, 2016 Accepting new patients
Independent Healthcare Management, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Fast Pace Mississippi, PLLC Family CurrentSince Oct 1, 2021 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Oct 1, 2021 Accepting new patients

Locations

330 N Broad St
#S
Forest, MS 39074
Phone (601) 469-4151

330 N Broad St
Forest, MS 39074
Phone (601) 469-4151

110 Pioneer Way
Magee, MS 39111

301 8th Ave SW
Ste B
Magee, MS 39111

376 Simpson Highway 149
Ste 300
Magee, MS 39111
Phone (601) 721-8985

347 S Fourth St
Morton, MS 39117
Phone (601) 732-1524

1017 W Beacon St
Philadelphia, MS 39350
Phone (769) 200-0730

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

Interoperability endpoints

  • Direct secure messaging: megan.otto@phspch.eclinicaldirectplus.com

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1473292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538352000000",
    "number": "1609323450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N BROAD ST",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390743508",
            "telephone_number": "601-469-4151",
            "fax_number": "601-469-3681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N BROAD ST",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390743508",
            "telephone_number": "601-469-4151",
            "fax_number": "601-469-3681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "MEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-08",
        "last_updated": "2018-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "901717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05531862",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, MS

Sources for this page

Verify at the official NPI Registry.