NPIMap

Individual provider Active NPI

Paul Russell Roberts, MD

  • Radiation Oncology Physician
  • Tupelo, MS
National Provider Identifier
1902392939
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
31784 Issued in MS
Practice address
990 S Madison St Ste 1
Tupelo, MS 38801-6308
Phone
(662) 377-4077
NPI assigned
Jul 2, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 31784 MS Primary

Addresses

Primary practice location

990 S Madison St Ste 1
Tupelo, MS 38801-6308

Mailing address

990 S Madison St Ste 1
Tupelo, MS 38801-6308

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
I20230901002091 MS Practitioner - Radiation Oncology 1951653245 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Mississippi School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clay County Medical Corporation 36 clinicians
North Mississippi Medical Center, Inc. 361 clinicians

Practice addresses (Care Compare)

111 Medical Ctr Dr
West Point, MS 39773-0428
Phone (662) 494-1509

1205 Hwy 182 W
Clay County Medical Corporation
Starkville, MS 39759-9820
Phone (662) 320-8545

150 Medical Ctr Dr
West Point, MS 39773-0428
Phone (601) 494-2321

187 Medical Ctr Dr
West Point, MS 39773-0428
Phone (662) 492-3175

835 Medical Ctr Dr
West Point, MS 39773

990 S Madison St
1 North Mississippi Medical Center Radiatio
Tupelo, MS 38801-6308
Phone (662) 377-4077

Hospital & facility affiliations

  • North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004
  • Clay County Medical Corporation Hospital, West Point, MS, CCN 250067
  • North Mississippi Medical Center-Gilmore Amory Hospital, Amory, MS, CCN 250025
  • Baptist Memorial Hospital Union County Hospital, New Albany, MS, CCN 250006

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31784MSMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medcial Center, Inc. CurrentSince Aug 1, 2023 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients
North Mississippi Medical Center, Inc. CurrentSince Aug 1, 2023 Accepting new patients
Clay County Medical Corporation Current Accepting new patients
Clay County Medical Corporation CurrentSince Aug 1, 2023 Accepting new patients
Clay County Medical Corporation Current Accepting new patients
Clay County Medical Corporation CurrentSince Aug 1, 2023 Accepting new patients
Clay County Medical Corporation Past Accepting new patients
Amory Surgery Clinic, PLLC Past Accepting new patients

Locations

1205 Highway 182 W
Starkville, MS 39759
Phone (662) 320-8545

990 S Madison St
#1
Tupelo, MS 38801
Phone (662) 377-4077

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

150 Medical Center Dr
West Point, MS 39773
Phone (601) 494-2321

Interoperability endpoints

  • Direct secure messaging: paulroberts@nmhs.medalliesdirect.net

Organizations & group practices 21

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.

View all 21

Hospital & facility affiliations 4

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": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1902392939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 S MADISON ST STE 1",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 S MADISON ST STE 1",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016308",
            "telephone_number": "662-377-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "PAUL",
        "middle_name": "RUSSELL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-02",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MS",
            "license": "31784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.