NPIMap

Organization Active NPI

Obstetrics Gynecology Associates PA

  • Obstetrics & Gynecology Physician
  • Tupelo, MS
National Provider Identifier
1750352894
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OBSTETRICS GYNECOLOGY ASSOCIATES PA
Practice address
1793 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone
(662) 842-1161
Fax
(662) 844-4107
NPI assigned
Jan 27, 2006
Last updated
Jan 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Authorized official

Name
Sherri Hodges
Title
Administrator
Phone
(662) 842-7080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1793 Cliff Gookin Blvd
Tupelo, MS 38801-6723

Mailing address

1793 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone (662) 842-1161

Other identifiers 2

IdentifierTypeStateIssuer
CM7073OtherMSRAILROAD MEDICARE GROUP
09014159MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040430000135 MS Part B Supplier - Clinic/Group Practice 3072500073 Receives reassigned benefits from 27 practitioners
Practice locations: Tupelo, 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
25D0316931Obstetrics Gynecology Associates PA1793 Cliff Gookin Blvd Ste a, Tupelo, MS 38801Provider-performed microscopyDec 13, 2027

National Provider Directory

National Provider Directory

Locations

1793 Cliff Gookin Blvd
Tupelo, MS 38801
Phone (662) 842-1161

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1750352894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1793 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-842-1161",
            "fax_number": "662-844-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1793 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-842-1161",
            "fax_number": "662-844-4107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSTETRICS GYNECOLOGY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-842-7080"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CM7073",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014159",
            "state": "MS"
        }
    ],
    "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 30, 2008; 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.