Individual provider Active NPI

Mark Garry Murray, M.D.

  • Allergy & Immunology Physician
  • Diberville, MS
National Provider Identifier
1669594974
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
21988 Issued in MS
Practice address
3200 Mallett Rd Ste D3
Diberville, MS 39540-9305
Phone
(228) 392-6875
Fax
(228) 392-6877
NPI assigned
Apr 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 21988 MS
Allergy & Immunology Physician 207K00000X 21988 MS Primary

Addresses

Primary practice location

3200 Mallett Rd Ste D3
Diberville, MS 39540-9305

Mailing address

1513 Lakeland Dr Ste 101
Jackson, MS 39216-4829
Phone (601) 354-4836

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120703000532 MS Practitioner - Allergy/ImmunologyPractitioner - Pediatric Medicine 0446310353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
University of South Alabama College of Medicine, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Mississippi Asthma and Allergy Clinic PAGroup PAC ID 7416993522, 14 clinicians

Practice addresses (Care Compare)

1513 Lakeland Dr
Suite 101
Jackson, MS 39216-4829
Phone (601) 354-4836

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.53 of 100Reported as group
Quality
61.06
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21988MSMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Mississippi Asthma & Allergy Clinic PA Allergy & Immunology CurrentSince Jul 9, 2013 Accepting new patients
Southeastern Emergency Physicians of Memphis LLC Past Accepting new patients

Locations

3200 Mallett Rd
Ste D3
Diberville, MS 39540
Phone (228) 392-0900

1513 Lakeland Dr
Ste 101
Jackson, MS 39216
Phone (601) 354-4836

1400 20th Ave
Ste C
Meridian, MS 39301
Phone (601) 693-0216

3704 Highway 39 N
Meridian, MS 39301
Phone (601) 693-0216

Organizations & group practices 2

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1669594974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1513 LAKELAND DR STE 101",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164829",
            "telephone_number": "601-354-4836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MALLETT RD STE D3",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395409305",
            "telephone_number": "228-392-6875",
            "fax_number": "228-392-6877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MURRAY",
        "first_name": "MARK",
        "middle_name": "GARRY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "21988",
            "primary": false
        },
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MS",
            "license": "21988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diberville, MS

Sources for this page

Verify at the official NPI Registry.