Active NPI
Elizabeth N Roy, MD
- Pediatrics Physician
- Vicksburg, MS
National Provider Identifier
1639115173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 12153
- Practice address
- 2100 Highway 61 N
Vicksburg, MS 39183-8211 - Phone
- (601) 883-5000
- NPI assigned
- Jun 22, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 12153 | MS | Primary |
Addresses
Primary practice location
2100 Highway 61 N
Vicksburg, MS 39183-8211
Mailing address
2100 Highway 61 N
Vicksburg, MS 39183-8211
Phone (601) 883-5000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4231266 | Other | MS | AETNA |
| 00114159 | Medicaid | MS | |
| 1908681 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219363200000",
"number": "1639115173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 HIGHWAY 61 N",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391838211",
"telephone_number": "601-883-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 HIGHWAY 61 N",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391838211",
"telephone_number": "601-883-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROY",
"first_name": "ELIZABETH",
"middle_name": "N",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-22",
"last_updated": "2008-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MS",
"license": "12153",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4231266",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00114159",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1908681",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.