MS. MARY S MISSAK M.D.
NPI 1962507061
Internal Medicine in Southaven, MS


Quality Rating: 82.06 out of 100 score

NPI Status: Active since September 13, 2006

Contact Information

7680 AIRWAYS BLVD
SOUTHAVEN, MS
ZIP 38671
Phone: (662) 349-1999
Fax: (662) 349-9734

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  • Individual
  • Female
  • Years of Experience 47
  • Internal Medicine
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled
  • Medicare Quality Reporting

About MARY MISSAK

This page provides the complete NPI Profile along with additional information for Mary Missak, an internist established in Southaven, Mississippi with a medical specialization in Internal Medicine and more than 47 years of experience. The healthcare provider is registered in the NPI registry with number 1962507061 assigned on September 2006. The practitioner's primary taxonomy code is 207R00000X with license number 16715 (MS). The provider is registered as an individual and her NPI record was last updated 18 years ago.

NPI
1962507061
Provider Name
MS. MARY S MISSAK M.D.
Other Name
MS. MARY SAMUEL M.D.
Other Name Type
Other Name (5)
Gender
Female
Entity Type
Individual
Location Address
7680 AIRWAYS BLVD SOUTHAVEN, MS 38671
Location Phone
(662) 349-1999
Location Fax
(662) 349-9734
Mailing Address
7680 AIRWAYS BLVD SOUTHAVEN, MS 38671
Mailing Phone
(662) 349-1999
Mailing Fax
(662) 349-9734
Medical School Name
OTHER
Graduation Year
1979
Is Sole Proprietor?
No
Enumeration Date
09-13-2006
Last Update Date
07-08-2007
Code Navigator

An internist like Mary Missak is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Internal Medicine

Taxonomy Code
207R00000X
Type
Allopathic & Osteopathic Physicians
License No.
16715
License State
MS
Taxonomy Description
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Blue HSA Bronze - PPO
  • Blue Protect - PPO
  • Blue Saver Bronze - PPO
  • Blue Value Gold - PPO
  • Blue Value Silver - PPO
  • Blue Access Gold for Business - PPO
  • Blue Choice Platinum for Business - PPO
  • Blue HSA Silver for Business - PPO
  • Blue Saver Bronze for Business - PPO
  • Blue Saver Gold for Business - PPO
  • Blue Secure Gold for Business - PPO
  • Blue Secure Silver for Business - PPO
  • BlueCross B07S HSA - EPO
  • BlueCross B15S $0 virtual care from Teladoc Health � - EPO
  • BlueCross B16S $50 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross B17S $0 virtual care from Teladoc Health � + Adult Dental - EPO
  • BlueCross G06S $35 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross G08S $30 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S25S $55 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S26S $40 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S27S $60 PCP Copay + $0 virtual care from Teladoc Health � - EPO
  • BlueCross S29S $60 PCP Copay + $0 virtual care from Teladoc Health � + Adult Dental - EPO
  • Connect Bronze 5500 Indiv Med Deductible Enhanced Diabetes Care - EPO
  • Connect Bronze 6500 Indiv Med Deductible - EPO
  • Connect Bronze 8500 Indiv Med Deductible - EPO
  • Connect Bronze CMS Standard - EPO
  • Connect Gold 2000 Indiv Med Deductible - EPO
  • Connect Gold CMS Standard - EPO
  • Connect Silver 3800 Indiv Med Deductible Enhanced Diabetes Care - EPO
  • Connect Silver 4000 Indiv Med Deductible - EPO
  • Connect Silver 6500 Indiv Med Deductible - EPO
  • Connect Silver CMS Standard - EPO
  • Bronze 4 - HMO
  • Bronze 8 - HMO
  • Gold 1 - HMO
  • Gold 1 with Adult Vision Services - HMO
  • Gold 8 - HMO
  • Silver 1 - HMO
  • Silver 1 with Adult Vision Services - HMO
  • Silver 12 with First 4 Primary Care Visits Free - HMO
  • Silver 8 - HMO
  • Bronze Classic 4700 - EPO
  • Bronze Classic Standard - EPO
  • Bronze Elite + PCP Saver Plus - EPO
  • Gold Classic - EPO
  • Gold Classic Standard - EPO
  • Gold Elite - EPO
  • Secure - EPO
  • Silver Classic - EPO
  • Silver Classic Standard - EPO
  • Silver Simple Breathe Easy with Enhanced COPD Benefits - EPO
  • Silver Simple Diabetes - EPO
  • Silver Simple PCP Saver - EPO
  • UHC Bronze Copay Focus (No Referrals) - EPO
  • UHC Bronze Copay Focus+ (Dental + Vision, No Referrals) - EPO
  • UHC Bronze Standard (No Referrals) - EPO
  • UHC Bronze Value (No Referrals) - EPO
  • UHC Gold Advantage (No Referrals) - EPO
  • UHC Gold Advantage+ (Dental + Vision, No Referrals) - EPO
  • UHC Gold Copay Focus (No Referrals) - EPO
  • UHC Gold Standard (No Referrals) - EPO
  • UHC Silver Advantage (No Referrals) - EPO
  • UHC Silver Advantage+ (Dental + Vision, No Referrals) - EPO
  • UHC Silver Copay Focus (No Referrals) - EPO
  • UHC Silver Standard (No Referrals) - EPO
  • EssentialSmile Tennessee - Total Care - EPO
  • Smile Now Tennessee - No Waiting Period PPO - PPO

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
3152270OTHER (01)TNBLUE CROSS
G79720MEDICARE UPIN (02) 
00122932MEDICAID (05)MS 
640922089001OTHER (01)TNCHAMPUS
3820790MEDICARE ID-TYPE UNSPECIFIED (04)TN 
00122932OTHER (01)MAILHANDLERS
3149420OTHER (01)TNTN BLUE CROSS FOR MS

Medicare Participation & PECOS Enrollment Status

Mary Missak is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Mary Missak is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 7416015904

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20081028000478

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

  • DME-Other DME (DE017N)

    Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (HCPCS:A4253)

    14 DME suppliers used 49 Medicare Claims 98 Services Paid

  • DME-Medical/Surgical Supplies (DA000N)

    Lancets, per box of 100 (HCPCS:A4259)

    7 DME suppliers used 19 Medicare Claims 21 Services Paid

  • DME-Other DME (DE017N)

    Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service (HCPCS:K0553)

    3 DME suppliers used 15 Medicare Claims 15 Services Paid

  • DME-Other DME (DE000N)

    Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)

    4 DME suppliers used 12 Medicare Claims 12 Services Paid

Drugs Administered Through DME

  • DME-Drugs Administered Through DME (DG006N)

    Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg (HCPCS:J7613)

    4 DME suppliers used 12 Medicare Claims 3689 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Annual alcohol misuse screening, 15 minutes

An annual alcohol misuse screening is a 15-minute check-up to assess your drinking habits. It helps identify if you're consuming alcohol in a way that could harm your health. This is not a judgment, but a tool to promote your wellbeing.

This service was performed 135 times for 135 patients

Annual depression screening, 15 minutes

An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.

This service was performed 130 times for 130 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

This service was performed 128 times for 128 patients

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month

Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.

This service was performed 32 times for 18 patients

Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19)

This is a test to detect COVID-19, the virus causing severe respiratory illness. It uses a method called immunoassay, which identifies the virus by its unique proteins. The test is directly observed for accuracy. It helps determine if you're currently infected.

This service was performed 18 times for 17 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 452 times for 235 patients

Established patient office or other outpatient visit, 30-39 minutes

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 124 times for 95 patients

Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician

An exercise or drug-induced heart stress test with ECG is a procedure to assess how your heart functions under stress. It can involve exercising or medication to make your heart work harder while an ECG records its activity. A physician reviews the results.

This service was performed 155 times for 155 patients

Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician

An exercise or drug-induced heart stress test with ECG involves monitoring your heart's activity while it's under stress, either from exercise or medication. A doctor supervises the entire procedure to ensure safety and accuracy in results. This test helps detect heart problems.

This service was performed 155 times for 155 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 15 times for 15 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 21 times for 21 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only

A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.

This service was performed 3,084 times for 2,072 patients

Physician Visit Costs



The typical physician office visit costs for Medicare beneficiaries in this area are: $30.1 for a new patient copayment and $23.05 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 38671 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99204

  • Average New Patient Price $120.41
  • Minimum New Patient Price $51.65
  • Maximum New Patient Price $159.18
  • Average New Patient Copayment $30.1
  • Minimum New Patient Copayment $12.91
  • Maximum New Patient Copayment $39.79

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99214

  • Average Established Patient Price $92.2
  • Minimum Established Patient Price $16.15
  • Maximum Established Patient Price $129.61
  • Average Established Patient Copayment $23.05
  • Minimum Established Patient Copayment $4.03
  • Maximum Established Patient Copayment $32.4

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 82.06, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

  • Final Score: 82.06 out of 100

    The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.

  • Quality Score: 100

    The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.

    There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.

  • Promoting Interoperability Score: 84

    The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.

    The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

  • Improvement Activities Score: 40

    The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.

    The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

  • Cost Score: 34.69

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

  • Cost Score: 34.69

    The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.

    Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure Performance Number of Patients
Breast Cancer Screening 63% 495
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Colorectal Cancer Screening 72% 707
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
Diabetes: Medical Attention for Nephropathy 81% 216
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
Documentation of Current Medications in the Medical Record 97% 2230
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration
Electronic submission of Patient Centered Medical Home accreditationYesN/A
I attest that I am a Patient Centered Medical Home (PCMH) or Comparable Specialty Practice that has achieved certification from a national program, regional or state program, private payer, or other body that administers patient-centered medical home accreditation and should receive full credit for the Improvement Activities performance category.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Mary Missak is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
BAPTIST MEMORIAL HOSPITAL DESOTO7601 SOUTHCREST PARKWAY
SOUTHAVEN, MS 38671
(662) 772-4000Acute Care Hospitals
METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL4250 BETHEL ROAD
OLIVE BRANCH, MS 38654
(662) 932-9000Acute Care Hospitals
BAPTIST MEMORIAL HOSPITAL6019 WALNUT GROVE ROAD
MEMPHIS, TN 38120
(901) 226-5000Acute Care Hospitals
METHODIST HOSPITALS OF MEMPHIS1265 UNION AVE SUITE 700
MEMPHIS, TN 38104
(901) 516-8274Acute Care Hospitals

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1962507061
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2912210014012
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 9 + 1 + 2 + 2 + 1 + 0 + 0 + 1 + 4 + 0 + 1 + 2 + 24 = 49
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 49 = 11

The NPI number 1962507061 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1083719199DR. LILY HERBERT M.D.
Individual
Internal Medicine7680 AIRWAYS BLVD
SOUTHAVEN, MS 38671
(662) 349-1999
1275638363MR. MAGDI S WASSEF M.D.
Individual
Internal Medicine7680 AIRWAYS BLVD
SOUTHAVEN, MS 38671
(662) 349-1999
1932259355SOUTHAVEN INTERNAL MEDICINE, P.C.
Organization
Internal Medicine7680 AIRWAYS BLVD
SOUTHAVEN, MS 38671
(662) 349-1999

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1962507061, enumerated in the NPI registry as an "individual" on September 13, 2006

The provider is located at 7680 Airways Blvd Southaven, Ms 38671 and the phone number is (662) 349-1999

The provider's speciality is Internal Medicine with taxonomy code 207R00000X

The provider has more than 47 years of experience.

The provider might be accepting Accepts: Blue Cross and Blue Shield of Alabama, BlueCross. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

The provider has an overall high rating in the following quality measures: quality clinical practices and patient outcomes and experiences , uses technology to exchange and make use of healthcare information.

Medicare beneficiaries should expect a typical cost of $120.41 with an average copayment of $30.1 for new patient appointments. Established patients should expect a typical charge of $92.2 and an average copayment of 23.05. Please review your insurance plan or contact the provider directly to determine your specific costs.

The most common procedures or services performed by this practitioner are: Annual alcohol misuse screening, 15 minutes, Annual depression screening, 15 minutes, Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit, Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month, Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19), Established patient office or other outpatient visit, 20-29 minutes, Established patient office or other outpatient visit, 30-39 minutes, Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician, Exercise or drug-induced heart stress test with electrocardiogram (ecg) with supervision by physician, New patient office or other outpatient visit, 30-44 minutes, New patient office or other outpatient visit, 45-59 minutes and Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only.

The practitioner is affiliated to the following hospital(s): BAPTIST MEMORIAL HOSPITAL DESOTO, METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL, BAPTIST MEMORIAL HOSPITAL and METHODIST HOSPITALS OF MEMPHIS. Hospital affiliations are identified through self-reporting data and service claims based on the place of service.

This NPI record was last updated on September 13, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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