Individual provider Active NPI

Raymond Y Whitehead, MD

  • Orthopaedic Surgery Physician
  • Hattiesburg, MS
National Provider Identifier
1962512525
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
17154 Issued in MS
Practice address
103 Medical Park FL 2
Hattiesburg, MS 39401-9042
Phone
(601) 268-5630
Fax
(601) 579-3285
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 17154 MS Primary

Addresses

Primary practice location

103 Medical Park FL 2
Hattiesburg, MS 39401-9042

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 268-5630

Other identifiers 3

IdentifierTypeStateIssuer
00123887MedicaidMS
1559341OtherMSAMERICAN ADMIN GROUP
1595152MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rwhitehead2514@directpatientrecord.com Health Information Exchange (HIE)

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
I20080201000376 MS Practitioner - Orthopedic Surgery 0446332258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Alabama School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

Hospital & facility affiliations

  • Forrest General Home Care Home health agency, Hattiesburg, MS, CCN 257127
  • Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078
  • South Central Reg Med Ctr Hospital, Laurel, MS, CCN 250058

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement45
Lower limb (leg) arthroscopy (minimally invasive joint repair)17
Upper limb (arm) arthroscopy (minimally invasive joint repair)67
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17154MSMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic, PA CurrentSince Jun 8, 2001 Accepting new patients
Hattiesburg Clinic PA CurrentSince Jun 8, 2001 Accepting new patients
Hattiesburg Clinic, PA Past Accepting new patients
State of Mississippi - University of Mississippi Medical Center PastSince May 12, 2024 Accepting new patients

Locations

415 S 28th Ave
Fl Fourth
Hattiesburg, MS 39401

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

103 Medical Park
Hattiesburg, MS 39401
Phone (601) 268-5630

103 Medical Park
Fl 2
Hattiesburg, MS 39401
Phone (601) 268-5630

Interoperability endpoints

  • Direct secure messaging: rwhitehead2514@directpatientrecord.com

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1962512525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-268-5630",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MEDICAL PARK FL 2",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394019042",
            "telephone_number": "601-268-5630",
            "fax_number": "601-579-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHEAD",
        "first_name": "RAYMOND",
        "middle_name": "Y",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MS",
            "license": "17154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00123887",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ADMIN GROUP",
            "identifier": "1559341",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1595152",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwhitehead2514@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "103 Medical Park Fl 2",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394019042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.