NPIMap

Individual provider Active NPI

Clinton Wood Collins, MD

  • Urology Physician
  • Jackson, MS
National Provider Identifier
1932318243
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
21716 Issued in MS
Practice address
2500 N State St
Division of Urology
Jackson, MS 39216
Phone
(601) 984-5186
Fax
(601) 984-5110
NPI assigned
May 22, 2007
Last updated
Apr 1, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X TL33026 SC
Urology Physician 208800000X 21716 MS Primary
Urology Physician 208800000X 205946 LA
Urology Physician 208800000X 0101250371 VA

Addresses

Primary practice location

2500 N State St
Division of Urology
Jackson, MS 39216

Mailing address

2500 N State St
Division of Urology
Jackson, MS 39216
Phone (601) 984-5186

Other identifiers 3

IdentifierTypeStateIssuer
02504711MedicaidMS
134224MedicaidMS
P01071194OtherMSRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190205001633 FL Practitioner - Urology 5991838021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Mississippi School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

710 Lomax St
Jacksonville, FL 32204-4015
Phone (904) 355-6583

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
205946LAMDUrology Physician
21716MSMDUrology Physician
TL33026SCMDUrology Physician
0101250371VAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Physician Specialists LLC CurrentSince Jan 1, 2019 Accepting new patients
Florida Physician Specialists LLC Current Accepting new patients
Florida Physician Specialists LLC Urology CurrentSince Jan 1, 2019 Accepting new patients
McIver Urological Clinic Urology Current Accepting new patients

Locations

1860 Town Hall Cir
Fleming Island, FL 32003
Phone (904) 520-6800

710 Lomax St
Jacksonville, FL 32204
Phone (904) 306-6781

710 Lomax St
Ste L
Jacksonville, FL 32204

8774 Perimeter Park Blvd
Jacksonville, FL 32216
Phone (904) 642-6100

1577 Roberts Dr
Ste 326
Jacksonville Beach, FL 32250
Phone (904) 270-2706

1715 Village Way
Orange Park, FL 32073
Phone (904) 264-8418

Interoperability endpoints

  • Direct secure messaging: clintoncollins@miuc.allscriptsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364774400000",
    "number": "1932318243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "address_2": "DIVISION OF UROLOGY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-984-5186",
            "fax_number": "601-984-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "address_2": "DIVISION OF UROLOGY",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-984-5186",
            "fax_number": "601-984-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "CLINTON",
        "middle_name": "WOOD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2013-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SC",
            "license": "TL33026",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MS",
            "license": "21716",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "LA",
            "license": "205946",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": "0101250371",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02504711",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134224",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01071194",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.