Individual provider Active NPI

Charles C Bush Jr., MD

  • Obstetrics & Gynecology Physician
  • Flowood, MS
National Provider Identifier
1932243946
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
07502 Issued in MS
Practice address
291 E Layfair Dr
Flowood, MS 39232-9527
Phone
(601) 936-9190
Fax
(601) 932-6714
NPI assigned
Feb 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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 07502 MS Primary

Addresses

Primary practice location

291 E Layfair Dr
Flowood, MS 39232-9527

Mailing address

291 E Layfair Dr
Flowood, MS 39232-9527
Phone (601) 936-9190

Other identifiers 1

IdentifierTypeStateIssuer
00019433MedicaidMS

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
I20090505000178 MS Practitioner - Obstetrics/Gynecology 2668520420 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
07502MSMDObstetrics & Gynecology Physician
7502MSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Healthcare for Women PA Obstetrics & Gynecology CurrentSince Nov 28, 1988 Accepting new patients

Locations

291 E Layfair Dr
Jackson, MS 39232
Phone (601) 932-2230

1020 N Flowood Dr
Jackson, MS 39232
Phone (601) 664-2424

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.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1932243946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 E LAYFAIR DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329527",
            "telephone_number": "601-936-9190",
            "fax_number": "601-932-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 E LAYFAIR DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329527",
            "telephone_number": "601-936-9190",
            "fax_number": "601-932-6714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "CHARLES",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MS",
            "license": "07502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00019433",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flowood, MS

Sources for this page

Verify at the official NPI Registry.