NPIMap

Individual provider Active NPI

Mark A Deloach, MD

  • Family Medicine Physician
  • Bay Springs, MS
National Provider Identifier
1679681894
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14545 Issued in MS
Practice address
16 S Sixth St
Bay Springs, MS 39422-9055
Phone
(601) 764-4501
Fax
(601) 764-2310
NPI assigned
Aug 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 14545 MS Primary

Addresses

Primary practice location

16 S Sixth St
Bay Springs, MS 39422-9055

Mailing address

PO Box 723
Bay Springs, MS 39422-0723
Phone (601) 340-3544

Other practice location 1

5135 Highway 84 W
Laurel, MS 39443
Phone (601) 340-3544

Other identifiers 1

IdentifierTypeStateIssuer
822838OtherWELLCARE

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
I20050722000525 MS Practitioner - Family Practice 4880620566 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Raleigh Family Health Clinic PLLCGroup PAC ID 5799902789, 3 clinicians
Calhoun Medical Clinic LLCGroup PAC ID 0941596084, 7 clinicians

Practice addresses (Care Compare)

20 S 6TH St
Deloach Family Clinic
Bay Springs, MS 39422-9055
Phone (601) 764-4501

5135 Hwy 84 W
Laurel, MS 39443-8587
Phone (601) 340-3544

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Calhoun Medical Clinic, LLC Family Medicine CurrentSince Sep 1, 2016 Accepting new patients
Pine Ridge Family Clinic, LLC CurrentSince Mar 1, 2020 Accepting new patients
Raleigh Family Health Clinic PLLC CurrentSince May 24, 2014 Accepting new patients
Eure-Lay Clinic Family Medicine Past Accepting new patients
Jasper County Nursing Home Past Accepting new patients

Locations

20 S Sixth St
Bay Springs, MS 39422
Phone (601) 764-4494

3248 Highway 49
Collins, MS 39428
Phone (601) 765-6834

122 Weisenberger Rd
Gluckstadt, MS 39110
Phone (601) 790-9098

5135 Highway 84 W
Laurel, MS 39443
Phone (601) 340-3544

111 Main St
Quitman, MS 39355
Phone (601) 557-5105

Interoperability endpoints

  • Direct secure messaging: mark.deloach.1@6104.direct.athenahealth.com
  • Direct secure messaging: mark.deloach.1@30937.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/21239/brand/1/csg/1/fhir/r4
  • Direct secure messaging: mark.deloach.1@21239.direct.athenahealth.com

Organizations & group practices 5

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 8

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679681894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 723",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394220723",
            "telephone_number": "601-340-3544",
            "fax_number": "601-651-2926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 S SIXTH ST",
            "city": "BAY SPRINGS",
            "state": "MS",
            "postal_code": "394229055",
            "telephone_number": "601-764-4501",
            "fax_number": "601-764-2310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5135 Highway 84 W",
            "address_purpose": "LOCATION",
            "city": "Laurel",
            "state": "MS",
            "postal_code": "39443",
            "country_code": "US",
            "telephone_number": "601-340-3544",
            "fax_number": "601-651-2926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELOACH",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "14545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "822838",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Springs, MS

Sources for this page

Verify at the official NPI Registry.