Individual provider Active NPI

Richard K. Ivey, M.D.

  • Surgery Physician
  • Laurel, MS
National Provider Identifier
1790703171
Registry record updated Oct 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
12509 Issued in MS
Practice address
1002 Jefferson St
Suite400
Laurel, MS 39440-4306
Phone
(601) 649-7802
Fax
(601) 428-7841
NPI assigned
Jul 17, 2006
Last updated
Oct 8, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 12509 MS Primary

Addresses

Primary practice location

1002 Jefferson St
Suite400
Laurel, MS 39440-4306

Mailing address

PO Box 247
Laurel, MS 39441-0247
Phone (601) 399-6169

Other identifiers 1

IdentifierTypeStateIssuer
00114933MedicaidMS

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
I20031218000545 MS Practitioner - General SurgeryPractitioner - Emergency Medicine 0941107940 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Mississippi School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Central Clinics, IncGroup PAC ID 4385876655, 117 clinicians

Practice addresses (Care Compare)

1002 Jefferson St
Laurel, MS 39440-4306

1203 Ave B
Ellisville, MS 39437-2080
Phone (601) 477-2226

1220 Jefferson St
Laurel, MS 39440-4355
Phone (601) 399-6169

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Mastectomy1-10
Removal of tissue1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12509MSMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Clinics, Inc CurrentSince Mar 1, 2014 Accepting new patients
Correct Care, Inc. CurrentSince Sep 1, 2013 Accepting new patients
South Central Clinics, Inc Current Accepting new patients
South Central Clinics, Inc CurrentSince Mar 1, 2014 Accepting new patients
South Central Clinics, Inc Surgery Past Accepting new patients
South Central Clinics, Inc. Past Accepting new patients

Locations

229 Saint John Ln
Covington, LA 70433
Phone (866) 875-9225

1203 B Ave
Ellisville, MS 39437
Phone (601) 477-8553

1007 Jefferson St
Laurel, MS 39440
Phone (601) 425-7522

1440 Jefferson St
Laurel, MS 39440
Phone (601) 428-0577

140 Burke Calhoun City Rd
Slate Spring, MS 38916
Phone (662) 628-6611

409 Tyler Holmes Dr
Winona, MS 38967
Phone (662) 283-3060

Interoperability endpoints

  • Direct secure messaging: kivey@direct.scrmc.com

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791417600000",
    "number": "1790703171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410247",
            "telephone_number": "601-399-6169",
            "fax_number": "601-399-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 JEFFERSON ST",
            "address_2": "SUITE400",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404306",
            "telephone_number": "601-649-7802",
            "fax_number": "601-428-7841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVEY",
        "first_name": "RICHARD",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MS",
            "license": "12509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114933",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.