Percy L Anderson Jr., D.P.M., C.W.S., CMET

Primary specialty

PodiatristTaxonomy code 213E00000X

License

80107 Issued in MS

Practice address

1815 Hospital Dr
Suite 434
Jackson, MS 39204-3425

Phone

(601) 502-1100

Fax

(601) 502-0111

NPI assigned

Oct 11, 2006

Last updated

Apr 1, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

California School of Podiatric Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interventional Diabetes Center LLCGroup PAC ID 1254742935, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: percy.anderson.p1@direct.gacfhc.nextgenshare.com

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.

• Interventional Diabetes Center, LLC

  • Clinic/Center
  • Lexington, MS
  • NPI 1649747825
  Medicare reassignment Care Compare group NPD
• The Wound & Podiatry Center

  • Foot Surgery Podiatrist
  • Jackson, MS
  • NPI 1356615512
  Authorized official Same address or phone
• Wound and Podiatry Center

  • Foot Surgery Podiatrist
  • Jackson, MS
  • NPI 1790051738
  NPD (past) Authorized official
• Intervene Diabetic Center LLC

  • Specialist
  • Lexington, MS
  • NPI 1821927468
  NPD
• G a Carmichael Family Health Center Inc

  • Family Medicine Physician
  • Belzoni, MS
  • NPI 1396363503
  NPD (past)
• G a Carmichael Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Canton, MS
  • NPI 1801952809
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459468800000",
    "number": "1982792198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1533",
            "address_2": "SUITE 434",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391301533",
            "telephone_number": "601-502-1100",
            "fax_number": "601-502-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 HOSPITAL DR",
            "address_2": "SUITE 434",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043425",
            "telephone_number": "601-502-1100",
            "fax_number": "601-502-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "PERCY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.P.M., C.W.S., CMET",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2016-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MS",
            "license": "80107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "640813898",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "640813898",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05984200",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "640813898",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "640813898",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leon Anderson Jr., DMD
• Luke Anderson, MD
• Marie Crispin Anderson, RN FNP
• Mark Anderson, MD
• Micheal Anderson Jr., CSS
• Rachel W Anderson, MS CCC-SLP
• Reshunda Anderson
• Stephen David Anderson, M.D.
• Stephen Davis Anderson, MD
• Tanericha Lashay Anderson

• Podiatrist in Jackson, MS
• Providers in Jackson, MS by specialty
• Podiatrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.