Active NPI
Clyde Bennett Phillips, MD
- Orthopaedic Surgery Physician
- Tupelo, MS
National Provider Identifier
1679571491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 08406
- Practice address
- 1464 Medical Park Cir
Tupelo, MS 38801-6595 - Phone
- (662) 844-8699
- Fax
- (662) 844-7087
- NPI assigned
- Jul 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 08406 | MS | Primary |
Addresses
Primary practice location
1464 Medical Park Cir
Tupelo, MS 38801-6595
Mailing address
PO Box 1768
Tupelo, MS 38802-1768
Phone (662) 844-8699
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00010415 | Medicaid | MS | |
| 2840610001 | Other | DMERC | |
| P00007401 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kenneth a Grinspun, M.D. P.a. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- Tupelo, MS
- NPI 1063536126
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233100800000",
"number": "1679571491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1768",
"city": "TUPELO",
"state": "MS",
"postal_code": "388021768",
"telephone_number": "662-844-8699",
"fax_number": "662-844-7087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1464 MEDICAL PARK CIR",
"city": "TUPELO",
"state": "MS",
"postal_code": "388016595",
"telephone_number": "662-844-8699",
"fax_number": "662-844-7087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "CLYDE",
"middle_name": "BENNETT",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-14",
"last_updated": "2009-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "MS",
"license": "08406",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00010415",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "2840610001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00007401",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.