Individual provider Active NPI

Gary M Schneider, DO

  • Internal Medicine Physician
  • Madison, MS
National Provider Identifier
1922254531
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21564 Issued in MS
Practice address
125 Fenwick Cir
Madison, MS 39110-7783
Phone
(205) 807-4279
Fax
(209) 290-3015
NPI assigned
Aug 14, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101025823 MI
Internal Medicine Physician 207R00000X 163395 AK
Internal Medicine Physician 207R00000X 21564 MS Primary
Internal Medicine Physician 207R00000X 34.00974 OH

Addresses

Primary practice location

125 Fenwick Cir
Madison, MS 39110-7783

Mailing address

125 Fenwick Cir
Madison, MS 39110-7783
Phone (205) 807-4279

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, IN2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110901000673 MS Practitioner - Internal Medicine 4284804196 Reassigns benefits to 1 organization
Practice locations: Jackson, MS
I20210125001272 IN Practitioner - Internal Medicine 4284804196

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
163395AKMDInternal Medicine Physician
21564MSMDInternal Medicine Physician
34.00974OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Careplus Lakeview Family Medicine CurrentSince Jul 30, 2011 Accepting new patients
River Oaks Management Company LLC Internal Medicine Current Accepting new patients
River Oaks Management Company Internal Medicine CurrentSince Jul 30, 2011 Accepting new patients
Reservoir Family Medical Clinic, PA Current Accepting new patients
Reliantmd Telehealth Group PLLC Internal Medicine Past Accepting new patients
Peter J Jensen MD PC Past Accepting new patients

Locations

350 Crossgates Blvd
Brandon, MS 39042
Phone (601) 824-8500

5903 Ridgewood Rd
Jackson, MS 39211
Phone (601) 376-2022

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7115/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1922254531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 FENWICK CIR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107783",
            "telephone_number": "205-807-4279",
            "fax_number": "209-290-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 FENWICK CIR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107783",
            "telephone_number": "205-807-4279",
            "fax_number": "209-290-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHNEIDER",
        "first_name": "GARY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-14",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101025823",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": "163395",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "21564",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34.00974",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

Verify at the official NPI Registry.