Mississippi Family Medicine P C

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MISSISSIPPI FAMILY MEDICINE P C

Practice address

940 Matthew Dr
Suite 2
Waynesboro, MS 39367-2522

Phone

(601) 671-8555

Fax

(601) 671-0777

NPI assigned

Jan 11, 2007

Last updated

Jul 20, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Barbara Dearman

Title

Insurance Clerk

Phone

(601) 671-8555

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Peyton Lowery Rogers, NP

  • Nurse Practitioner
  • Waynesboro, MS
  • NPI 1841575933
  Medicare reassignment Care Compare group NPD
• Charles Todd Stokley, MD

  • Family Medicine Physician
  • Waynesboro, MS
  • NPI 1851488514
  Medicare reassignment Care Compare group NPD
• Kendall Shea Thornton, FNP

  • Nurse Practitioner
  • Leakesville, MS
  • NPI 1134491806
  Medicare reassignment Care Compare group NPD
• Marshall Scott Tynes, DO

  • Family Medicine Physician
  • Meridian, MS
  • NPI 1063509719
  NPD (past)
• Jeanna Lynn Knoble, MD

  • Hematology & Oncology Physician
  • Columbus, OH
  • NPI 1548242118
  NPD (past)
• Shelley L Snodgrass, MD

  • Internal Medicine Physician
  • Fishersville, VA
  • NPI 1154345932
  NPD (past)

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1669522942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "940 MATTHEW DR",
            "address_2": "SUITE 2",
            "city": "WAYNESBORO",
            "state": "MS",
            "postal_code": "393672522",
            "telephone_number": "601-671-8555",
            "fax_number": "601-671-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 MATTHEW DR",
            "address_2": "SUITE 2",
            "city": "WAYNESBORO",
            "state": "MS",
            "postal_code": "393672522",
            "telephone_number": "601-671-8555",
            "fax_number": "601-671-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI FAMILY MEDICINE P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "DEARMAN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "INSURANCE CLERK",
        "authorized_official_telephone_number": "601-671-8555",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. STOKLEY",
            "identifier": "00964",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. TYNES",
            "identifier": "009700450",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0113843",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. TYNES",
            "identifier": "073075294TYN",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER ID",
            "identifier": "C02214",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. STOKLEY",
            "identifier": "279588",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. STROKLEY",
            "identifier": "009926375",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTOGBA - RAILROAD MEDICARE",
            "identifier": "CD1005",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0117444",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. TYNES",
            "identifier": "279588",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Magnolia Smiles Family Dentistry,PLLC
• James K McCann
• Sara Beth McGee, NP
• Susan R McGee, M.D.
• Medi Port Transporation LLC
• Mississippi State Department of Health
• Auburn Ansley Moak, DMD
• Brandon Brian Moak, DMD
• Ms Hud Pine View LLC (Pine View Health and Rehabilitation Center)
• Mandy Yvette Munn, FNP

• Primary Care Clinic/Center in Waynesboro, MS
• Providers in Waynesboro, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.