NPIMap

Individual provider Active NPI

Fred J McDonnell, MD

  • Family Medicine Physician
  • Hazlehurst, MS
National Provider Identifier
1891897260
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7034 Issued in MS
Practice address
213 Caldwell Drive
Hazlehurst, MS 39083
Phone
(601) 894-4661
Fax
(601) 894-2514
NPI assigned
Sep 5, 2006
Last updated
Jul 10, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 7034 MS Primary

Addresses

Primary practice location

213 Caldwell Drive
Hazlehurst, MS 39083

Mailing address

213 Caldwell Drive
Hazlehurst, MS 39083
Phone (601) 894-4661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080725000422 MS Practitioner - Family Practice 1759387053 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Copiah County Medical CenterGroup PAC ID 2062583487, 19 clinicians

Practice addresses (Care Compare)

27190 Hwy 28
Hazlehurst, MS 39083-2224
Phone (601) 574-7000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7034MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Copiah County Medical Center Family Medicine CurrentSince May 1, 2008 Accepting new patients
Copiah County Medical Center CurrentSince May 1, 2022 Accepting new patients
Copiah County Medical Center Family Medicine CurrentSince May 1, 2022 Accepting new patients
Hardy Wilson Memorial Hospital Past Accepting new patients

Locations

123 Bo Bo Dr
Crystal Springs, MS 39059
Phone (601) 892-2225

213 Caldwell Dr
Hazlehurst, MS 39083
Phone (601) 892-2225

27190 Highway 28
Hazlehurst, MS 39083
Phone (601) 574-7000

Organizations & group practices 4

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 7

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": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373414400000",
    "number": "1891897260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 CALDWELL DRIVE",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "39083",
            "telephone_number": "601-894-4661",
            "fax_number": "601-894-2514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 CALDWELL DRIVE",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "39083",
            "telephone_number": "601-894-4661",
            "fax_number": "601-894-2514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONNELL",
        "first_name": "FRED",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2013-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "7034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazlehurst, MS

Sources for this page

Verify at the official NPI Registry.