Bobby E Proctor, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20742 Issued in MS

Practice address

286 Calhoun Station Parkway
Madison, MS 39110

Phone

(601) 200-4321

NPI assigned

May 23, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bobby.proctor.1@23284.direct.athenahealth.com
• Direct secure messaging: bobby.proctor@40481587920900.direct.elationemr.com

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.

• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Ripley, MS
  • NPI 1447769559
  Medicare reassignment NPD
• Fast Pace Mississippi, PLLC

  • Rural Health Clinic/Center
  • Kosciusko, MS
  • NPI 1851050579
  NPD
• South Central Clinics, Inc

  • Rural Health Clinic/Center
  • Laurel, MS
  • NPI 1669609111

  Family Medicine

  NPD (past)
• St Dominic Medical Associates LLC

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1508263179
  NPD (past)
• St. Dominic Medical Associates LLC

  • Family Medicine Physician
  • Madison, MS
  • NPI 1245393255
  NPD (past)
• Doctors Health Group, Inc

  • Family Medicine Physician
  • Jonesboro, AR
  • NPI 1225221211
  NPD (past)

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1801006960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 CALHOUN STATION PARKWAY",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110",
            "telephone_number": "601-200-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Southlake Cir",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MS",
            "postal_code": "390465368",
            "country_code": "US",
            "telephone_number": "601-859-9931",
            "fax_number": "601-859-8556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "BOBBY",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2019-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "20742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09150777",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Therapy Solutions, LLC
• Vicki Louise Prosser, PH.D
• Haley Puckett, PT
• Danielle Pugh
• Ashley Burleson Pullen, M.D.

• Family Medicine Physician in Madison, MS
• Providers in Madison, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.