NPIMap

Organization Active NPI

Mississippi Retina Associates,PLLC

  • Retina Specialist (Ophthalmology) Physician
  • Madison, MS
National Provider Identifier
1740357334
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
MISSISSIPPI RETINA ASSOCIATES,PLLC
Practice address
1026 Baptist Cir Ste 400
Madison, MS 39110-2028
Phone
(601) 981-4091
Fax
(601) 981-5039
NPI assigned
Nov 29, 2006
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Michael Jude BorneNPI 1588750178
Title
President
Phone
(601) 981-4091

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X MS
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

1026 Baptist Cir Ste 400
Madison, MS 39110-2028

Mailing address

1200 N State St
Suite 300
Jackson, MS 39202-2001
Phone (601) 981-4091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031208000521 MS Part B Supplier - Clinic/Group Practice 4880590330 Receives reassigned benefits from 8 practitioners
Practice locations: Madison, MS

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2272053Mississippi Retina Associates PLLC1026 Baptist Circle, Suite 400, Madison, MS 39110Certificate of waiverNov 13, 2026

National Provider Directory

National Provider Directory

Locations

1190 N State St
Ste 500
Jackson, MS 39202
Phone (601) 981-4091

1200 N State St
Ste 300
Jackson, MS 39202
Phone (601) 981-4091

1026 Baptist Cir
Madison, MS 39110

Interoperability endpoints

  • Direct secure messaging: bpropes@msretina.intellechartdirect.net
  • Direct secure messaging: jherring@msretina.intellechartdirect.net
  • Direct secure messaging: mborne@msretina.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1740357334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N STATE ST",
            "address_2": "SUITE 300",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022001",
            "telephone_number": "601-981-4091",
            "fax_number": "601-981-5039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 BAPTIST CIR STE 400",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391102028",
            "telephone_number": "601-981-4091",
            "fax_number": "601-981-5039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI RETINA ASSOCIATES,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "BORNE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-981-4091"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.