Clifton Dewayne Reed
Individual provider Active NPI Family Nurse Practitioner · Shaw, MS
NPI 1912480328 · NPPES record last updated Sep 11, 2018
Key facts
- NPI
- 1912480328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R877471 (MS)
- Practice address
- 112 W Peeler Ave
Shaw, MS 38773-8710 - Phone
- (662) 754-3304
- Fax
- (662) 754-3301
- NPI assigned
- Sep 11, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 15
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- May accept Medicare assignment
- Group practices
- North Sunflower Medical Center
Practice addresses (Care Compare)
1800 Cheryl St
Clarksdale, MS 38614-7219
Phone (662) 721-0050
202 S Ruby Ave
Ruleville, MS 38771-3227
Phone (662) 756-2500
840 N Oak Ave
Ruleville, MS 38771-3227
860 N Oak Ave
Ruleville, MS 38771-3227
Hospital & facility affiliations
- Northwest Missississippi Regional Medical Center
- North Sunflower Medical Center Cah
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181213001255 | MS | Practitioner - Nurse Practitioner | 6406191865 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R877471 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shaw Family Medical, LLC | Family | Current |
Accepting new patients |
| Shaw Family Medical, LLC | Current | Accepting new patients | |
| North Sunflower Medical Center | Current | Accepting new patients | |
| North Sunflower Medical Center | Current |
Accepting new patients | |
| North Sunflower Medical Center | Current |
Accepting new patients | |
| Thrive Medical & Wellness, PLLC | Family | Current |
Accepting new patients |
Locations
1800 Cheryl St
Clarksdale, MS 38614
Phone (662) 374-0015
840 N Oak Ave
Ruleville, MS 38771
Phone (601) 756-2711
840 N Oak Ave
Ste 101
Ruleville, MS 38771
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R877471 | MS | Yes |
Addresses
Primary practice location
112 W Peeler Ave
Shaw, MS 38773-8710
Mailing address
112 W Peeler Ave
Shaw, MS 38773-8710
Phone (662) 754-3304
Other providers in Shaw, MS
- Making Moves in the Community, Incorporated
- Maximum Care After Hours Clinic, LLC
- Corissa McClure
- Ronnie Lane Poe
- Preservers of Life Hospice
- Kimberly Robinson
- La Robinson
- Shaw Community Care Clinic
- Shaw Community Care Clinic
- Shaw Family Medical, LLC
All providers in Shaw, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.