Individual provider Active NPI

Eric Jermaine Warren, M.D.

  • Psychiatry Physician
  • Brandon, MS
National Provider Identifier
1730114117
Registry record updated Jan 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
16517 Issued in MS
Practice address
613 Marquette Rd
Brandon, MS 39042-3038
Phone
(601) 824-0342
Fax
(601) 824-0349
NPI assigned
Jul 12, 2006
Last updated
Jan 8, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 16517 MS Primary

Addresses

Primary practice location

613 Marquette Rd
Brandon, MS 39042-3038

Mailing address

PO Box 88
Brandon, MS 39043-0088
Phone (601) 824-0342

Other identifiers 1

IdentifierTypeStateIssuer
00125912MedicaidMS

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
I20040810001413 MS Practitioner - Psychiatry 2062484991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Mississippi School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Madison Rankin Simpson Mental HealthGroup PAC ID 4284671181, 8 clinicians

Practice addresses (Care Compare)

613 Marquette Rd
Brandon, MS 39042-3038
Phone (601) 824-0342

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Rankin Simpson Mental Health CurrentSince Mar 9, 2013 Accepting new patients
Southwest Mississippi Mental Health Mental Retardation Commission Past Accepting new patients

Locations

613 Marquette Rd
Brandon, MS 39042
Phone (601) 824-0342

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389139200000",
    "number": "1730114117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390430088",
            "telephone_number": "601-824-0342",
            "fax_number": "601-824-0349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 MARQUETTE RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390423038",
            "telephone_number": "601-824-0342",
            "fax_number": "601-824-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "ERIC",
        "middle_name": "JERMAINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2014-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "16517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125912",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

Verify at the official NPI Registry.