Active NPI
John T Chmelicek, MD
- Family Medicine Physician
- Purvis, MS
National Provider Identifier
1669488490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 13049
- Practice address
- 102 Shelby Speights Dr
Purvis, MS 39475-4151 - Phone
- (601) 794-8065
- Fax
- (601) 794-5650
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 13049 | MS | Primary |
Addresses
Primary practice location
102 Shelby Speights Dr
Purvis, MS 39475-4151
Mailing address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 794-8065
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1677841 | Medicaid | LA | |
| 00110831 | Medicaid | MS | |
| 1558928 | Other | MS | AMERICAN ADMIN GROUP |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13049 | MS | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1669488490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 S 28TH AVE",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394017246",
"telephone_number": "601-794-8065",
"fax_number": "601-794-5650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 SHELBY SPEIGHTS DR",
"city": "PURVIS",
"state": "MS",
"postal_code": "394754151",
"telephone_number": "601-794-8065",
"fax_number": "601-794-5650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHMELICEK",
"first_name": "JOHN",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MS",
"license": "13049",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1677841",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00110831",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN ADMIN GROUP",
"identifier": "1558928",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Purvis, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.