NPIMap

Individual provider Active NPI

Robert A. Gannaway, M.D.

  • Family Medicine Physician
  • Crystal Springs, MS
National Provider Identifier
1649227745
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12331 Issued in MS
Practice address
408 E Railroad Ave
Suite B
Crystal Springs, MS 39059-2520
Phone
(601) 892-7860
Fax
(601) 892-7861
NPI assigned
May 27, 2006
Last updated
Sep 16, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12331 MS Primary

Addresses

Primary practice location

408 E Railroad Ave
Suite B
Crystal Springs, MS 39059-2520

Mailing address

408 E Railroad Ave
Suite B
Crystal Springs, MS 39059-2520
Phone (601) 892-7860

Other identifiers 1

IdentifierTypeStateIssuer
01529794MedicaidMS

Other names 1

  • Robert A. Gannaway Professional name

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
I20050128000790 MS Practitioner - Family Practice 4587614599 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12331MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Noxubee General Critical Access Hospital CurrentSince Jan 11, 2020 Accepting new patients
Keystone Medical Services of Ms, Inc CurrentSince Mar 29, 2009 Accepting new patients
South Sunflower County Hospital CurrentSince Dec 23, 2020 Accepting new patients
Dobbs Emergency Group, LLC CurrentSince Mar 23, 2020 Accepting new patients
South Sunflower County Hospital Current Accepting new patients
Noxubee General Critical Access Hospital CurrentSince Jan 11, 2020 Accepting new patients
South Sunflower County Hospital Current Accepting new patients
South Sunflower County Hospital CurrentSince Dec 23, 2020 Accepting new patients
Family Medical Clinic of Crystal Springs PLLC Family Medicine PastSince Jan 1, 2004 Accepting new patients

Locations

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

121 E Baker St
Indianola, MS 38751
Phone (601) 887-3113

78 Hospital Rd
Macon, MS 39341
Phone (662) 726-4231

300 SE 3rd Ave
Magee, MS 39111
Phone (601) 849-5070

140 Burke Calhoun City Rd
Slate Spring, MS 38916
Phone (662) 628-6611

100 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-0455

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284595200000",
    "number": "1649227745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 E RAILROAD AVE",
            "address_2": "SUITE B",
            "city": "CRYSTAL SPRINGS",
            "state": "MS",
            "postal_code": "390592520",
            "telephone_number": "601-892-7860",
            "fax_number": "601-892-7861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 E RAILROAD AVE",
            "address_2": "SUITE B",
            "city": "CRYSTAL SPRINGS",
            "state": "MS",
            "postal_code": "390592520",
            "telephone_number": "601-892-7860",
            "fax_number": "601-892-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNAWAY",
        "first_name": "ROBERT",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2010-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "12331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01529794",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERT",
            "last_name": "GANNAWAY",
            "middle_name": "A.",
            "credential": "M.D., PLLC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Crystal Springs, MS

Sources for this page

Verify at the official NPI Registry.