NPIMap

Individual provider Active NPI

Gary Alan Roberson, M. D.

  • Psychiatry Physician
  • Whitfield, MS
National Provider Identifier
1629133400
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
15474 Issued in MS
Practice address
3550 Highway 468 West
Whitfield, MS 39193-0157
Phone
(601) 351-8000
Fax
(601) 351-8301
NPI assigned
Dec 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 15474 MS Primary

Addresses

Primary practice location

3550 Highway 468 West
Whitfield, MS 39193-0157

Mailing address

1855 Lakeland Dr
Suite P-231
Jackson, MS 39216-4913
Phone (601) 906-4479

Other identifiers 2

IdentifierTypeStateIssuer
008124779MedicaidMS
260002937OtherMNMEDICARE PTAN

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
I20040120000367 MS Practitioner - Psychiatry 1456252618 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
MDB Behavioral Health Services LLC Psychiatry CurrentSince Nov 19, 2013 Accepting new patients
Forrest County General Hospital CurrentSince Jun 13, 2012 Accepting new patients
Patients Choice Medical Center of Humphreys County, LLC Past Accepting new patients
South Mississippi Health Service, Inc Psychiatry Past Accepting new patients
Minneapolis Clinic of Neurology, LTD PastSince Jan 1, 2009 Accepting new patients
Warren Yazoo Mental Health Service Past Accepting new patients
Paradigm Health Psychiatric SRV, LLC Psychiatry PastSince Feb 8, 2011 Accepting new patients
MDB Care Management LLC PastSince Apr 6, 2023 Accepting new patients

Locations

557 Grants Ferry Rd
Brandon, MS 39047
Phone (601) 207-2017

215 Katherine Dr
Flowood, MS 39232

2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050

1 Lincoln Pkwy
Ste 202
Hattiesburg, MS 39402
Phone (601) 288-8050

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

215 Katherine Dr
#A
Jackson, MS 39232

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Minor Med Care, LLCRaymond, MS, CCN 253903 Rural health clinic 5% Or Greater Indirect Ownership Interest (48.5%) Oct 12, 2023
Complete Care Rural Health ClinicVicksburg, MS, CCN 253808 Rural health clinic 5% Or Greater Indirect Ownership Interest (49.5%) Apr 1, 2019
Dba Complete Care of GreenvilleGreenville, MS, CCN 258901 Rural health clinic 5% Or Greater Indirect Ownership Interest (49%) Aug 7, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1629133400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 LAKELAND DR",
            "address_2": "SUITE P-231",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164913",
            "telephone_number": "601-906-4479",
            "fax_number": "601-366-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 HIGHWAY 468 WEST",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000",
            "fax_number": "601-351-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "GARY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "15474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008124779",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "260002937",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whitfield, MS

Sources for this page

Verify at the official NPI Registry.