Individual provider Active NPI

Mark Ray, M.D.

  • Obstetrics & Gynecology Physician
  • Tupelo, MS
National Provider Identifier
1922022060
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
13204 Issued in MS
Practice address
1041 S Madison St
Tupelo, MS 38801-6309
Phone
(662) 844-8754
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 13204 MS Primary

Addresses

Primary practice location

1041 S Madison St
Tupelo, MS 38801-6309

Mailing address

1041 S Madison St
Tupelo, MS 38801-6309
Phone (662) 844-8754

Other identifiers 1

IdentifierTypeStateIssuer
0115096MedicaidMS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20101015001138 MS Practitioner - Obstetrics/Gynecology 2163501024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Mississippi School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanders Clinic for Women P.a.Group PAC ID 9537136254, 12 clinicians

Practice addresses (Care Compare)

1041 S Madison St
Tupelo, MS 38801-6309
Phone (601) 844-8754

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.94 of 100Reported as group
Quality
96.59
Promoting interoperability
100
Improvement activities
40
Cost
79.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13204MSMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanders Clinic for Women PA Obstetrics & Gynecology CurrentSince Jun 12, 1995 Accepting new patients

Locations

1041 S Madison St
Tupelo, MS 38801
Phone (601) 844-8754

Interoperability endpoints

  • Direct secure messaging: mark.ray.1@13706.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/13706/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Childrens Clinic - TupeloTupelo, MS, CCN 258551 Rural health clinic Corporate Director Oct 1, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1922022060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1041 S MADISON ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016309",
            "telephone_number": "662-844-8754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 S MADISON ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016309",
            "telephone_number": "662-844-8754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAY",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MS",
            "license": "13204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115096",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.