Gary M Davis, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

11174 Issued in MS

Practice address

5903 Ridgewood Rd
Ste 340
Jackson, MS 39211

Phone

(601) 899-3340

Fax

(601) 899-3343

NPI assigned

Dec 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 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

Specialty

NephrologyAlso: Internal Medicine

Education

Meharry Medical College School of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Diversified Renal Group LLCGroup PAC ID 6406815299, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DRG Fayette Dialysis facility, Fayette, MS, CCN 252571

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: gary.davis@direct.davitaphysiciansolutions.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.

• Diversified Renal Group LLC

  • Nephrology Physician
  • Jackson, MS
  • NPI 1184792038
  Medicare reassignment Care Compare group Authorized official
• Mississippi Vascular Center, PLLC

  • Nephrology Physician
  • Jackson, MS
  • NPI 1841602257
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912065251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2057",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "39158",
            "telephone_number": "601-899-3340",
            "fax_number": "601-899-3343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5903 RIDGEWOOD RD",
            "address_2": "STE 340",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39211",
            "telephone_number": "601-899-3340",
            "fax_number": "601-899-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "GARY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MS",
            "license": "11174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115962",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Gay Davis
• Dereck Davis
• Derrick Dewayner Davis
• Emily Davis, FNP
• Fred G. Davis Sr., LPC
• Haden Davis
• Hope Catrina Davis
• Jacqueline Davis
• James Charles Davis Jr., CRNA
• Janice Hunter Davis, RN

• Nephrology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Nephrology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.