NPIMap

Individual provider Active NPI

Timothy R Ivey, M.D.

  • Internal Medicine Physician
  • Vancleave, MS
National Provider Identifier
1902802333
Registry record updated Dec 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
13532 Issued in MS
Practice address
11700 Highway 57
Vancleave, MS 39565-8309
Phone
(228) 826-1482
Fax
(228) 826-5924
NPI assigned
Jun 21, 2005
Last updated
Dec 29, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 13532 MS Primary

Addresses

Primary practice location

11700 Highway 57
Vancleave, MS 39565-8309

Mailing address

11700 Highway 57
Vancleave, MS 39565-8309
Phone (228) 826-1482

Other identifiers 1

IdentifierTypeStateIssuer
00115653MedicaidMS

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
I20051215000533 MS Practitioner - Internal Medicine 2062433261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Mississippi School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

11700 Hwy 57
Vancleave, MS 39565-8309
Phone (228) 826-1482

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System CurrentSince Sep 1, 2015 Accepting new patients
Singing River Health System Internal Medicine Past Accepting new patients
Meridian Hma LLC Past Accepting new patients
Meridian Hma LLC Past Accepting new patients

Locations

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

11700 Highway 57
Vancleave, MS 39565
Phone (228) 826-1482

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 6

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451347200000",
    "number": "1902802333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11700 HIGHWAY 57",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395658309",
            "telephone_number": "228-826-1482",
            "fax_number": "228-826-5924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11700 HIGHWAY 57",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395658309",
            "telephone_number": "228-826-1482",
            "fax_number": "228-826-5924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVEY",
        "first_name": "TIMOTHY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2015-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "13532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115653",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancleave, MS

Sources for this page

Verify at the official NPI Registry.