John David Fagan, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

12624 Issued in MS

Practice address

2200 Highway 61 N
Vicksburg, MS 39183-8246

Phone

(601) 883-5940

NPI assigned

Jul 5, 2006

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 3

Electronic endpoints 2

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

Specialty

Urology

Education

University of Texas Medical Branch at Galveston, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vicksburg Clinic LLCGroup PAC ID 5890696330, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Merit Health River Region Hospital, Vicksburg, MS, CCN 250031
• University of Mississippi Med Center Hospital, Jackson, MS, CCN 250001
• Merit Health Natchez Hospital, Natchez, MS, CCN 250084

Merit-based Incentive Payment System (MIPS)

Final score

88.07 of 100Reported as apm

Quality

73.89

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: john.fagan.1@1475.direct.athenahealth.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.

• Vicksburg Clinic LLC

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1790711158
  Medicare reassignment Care Compare group
• Vicksburg Clinic LLC

  • Infectious Disease Physician
  • Vicksburg, MS
  • NPI 1659307791

  Urology

  NPD (past)
• Vicksburg Clinic LLC

  • Family Medicine Physician
  • Tallulah, LA
  • NPI 1831308816

  Urology

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Natchez Hospital Company LLC

  • General Acute Care Hospital
  • Natchez, MS
  • NPI 1164821559
  Care Compare affiliation
• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Care Compare affiliation
• Vicksburg Healthcare LLC

  • General Acute Care Hospital
  • Vicksburg, MS
  • NPI 1215981303
  Care Compare affiliation

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1801827019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 SOUTH FRONTAGE RD",
            "address_2": "SUITE 100",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39180",
            "telephone_number": "601-262-1000",
            "fax_number": "601-262-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HIGHWAY 61 N",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838246",
            "telephone_number": "601-883-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MS",
            "license": "12624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00016970",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4547365",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1901474",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.fagan.1@direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "2080 South Frontage Rd",
            "address_2": "Suite 100",
            "city": "Vicksburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "39180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.fagan.1@direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "2200 Highway 61 N",
            "city": "Vicksburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391838246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samonia Lynn Etheridge, LPC
• Carrie Eure, PA-C
• Hope Evans, MS SLP/CCC
• Excel Care
• Eyeline Optical of Vicksburg Inc
• Lisa D Fairchild, MD
• Faith Therapy Practice
• Fast Pace Mississippi, PLLC
• Marcie Renee Felix, LPN
• Eugene B Ferris, MD

• Urology Physician in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Urology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.
• 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.