Run Time: 11:00 AM FOR THE STATE OF MISSISSIPPI Run Date ...

[Pages:405]Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

04180367 1396703351 AARON, JOSHUA N MD

03481574 1760492037 ABAI, AJA A MD

05926015 1417930884 ABANGAN, ROLANDO T MD

00931072 1790081156 ABAVARE, CHARLES K DO

09705504 1598253858 ABBAS, KANIZ MD

00115622 1669485983 ABBOUD, ELIAS H MD

02000267 1720660335 ABBOUD, ROMY E PA

07558801 1851824171 ABDALLAH AHMED, ABDU M MD

01070912 1841685773 ABDALLAH, ABDALLAH MD

00176849 1902314693 ABDEEN, SARAH L PA-C

09922811 1831159037 ABDEL-AZIZ, AHMED S MD

04303758 1093014441 ABDEL-KARIM, ABDUL-RAHMAN R MD

04928312 1821392275 ABDELKARIM, AHMAD A

00938281 1386804110 ABDULLAH, ABDULLAH N MD

05135263 1073049805 ABDUR RAHMAN, MANAL M MD

04677873 1134356272 ABEL, KEVIN MD

00002751 1891194635 ABI SALEH, ROLA MD

09703821 1376544106 ABIDE JR, PAUL E MD

04681893 1164984738 ABISAMRA, HALA J MD

05556231 1528556362 ABLES, HOLLIE E MD

06951091 1841782737 ABLES, JULIE A DMD

05133858 1427632405 ABRAHAM, GENE G M.D.

00114239 1184669798 ABRAHAM, GEORGE MD

04021333 1518052257 ABRAHAM, GEORGE E MD

02324046 1881049443 ABRAHAM, RALPH MD

08577555 1316319353 ABRAHAM, WHITNEY W FNP-C

08575830 1487098463 ABRAHAMS, MICHAEL MD

02102790 1184940405 ABRAMS JR, WINFRED B MD

CITY GULFPORT HATTIESBURG MERIDIAN TUPELO OXFORD LEXINGTON FLOWOOD JACKSON JACKSON JACKSON GREENWOOD OLIVE BRANCH JACKSON OLIVE BRANCH HATTIESBURG BALDWYN JACKSON GREENVILLE JACKSON MENDENHALL STARKVILLE GREENVILLE WATER VALLEY JACKSON OXFORD COLUMBUS GREENVILLE SOUTHAVEN

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

1

12:11:22 PM

Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

05736588 1376620849 ABRAMS, MARY E NP

03471208 1255658589 ABSTON, TIMOTHY A MD

00123298 1356482459 ABU-HAMDAN, KHALED N MD

05808556 1861797193 ABULFARAJ, MOAZ MD

00117215 1124062492 ABUSAA, TAYSIR M MD

00113758 1720060551 ACOSTA, JOSEPH R

04172869 1629194212 ACOTT, ALISON A MD

02528740 1528263936 ADAMS JR, JOHN D MD

06278532 1396993663 ADAMS, AMY D DO

07175579 1013204742 ADAMS, ANDREW B MD

01628047 1073533261 ADAMS, BARBARA J

08709246 1154796365 ADAMS, BRIAN D FNP

02684069 1437540184 ADAMS, CASEY NP

03459551 1497158034 ADAMS, CHRISTIN NP

09537703 1114969011 ADAMS, CRAIG V MD

03135597 1396165387 ADAMS, DANIEL MD

05336815 1235170267 ADAMS, DARRYL L CFNP

00116484 1033137658 ADAMS, DENNIS U MD

08426835 1326625310 ADAMS, DOMINIC MD

00016917 1194811471 ADAMS, HANS W MD

00854539 1023458452 ADAMS, JEREMY C MD

00124952 1780652362 ADAMS, JODY T NP

00116772 1669561692 ADAMS, JOHN L MD

05075871 1912003005 ADAMS, JOSEPH C MD

09628731 1679109458 ADAMS, KARI A NNP

08155004 1093206252 ADAMS, MICHAEL M DO

07687839 1760096127 ADAMS, SARAH NP

01459341 1659733632 ADAMS, SARAH A DO

CITY COLUMBUS JACKSON GREENVILLE WAYNESBORO JACKSON MERIDIAN JACKSON JACKSON LAUREL DIAMONDHEAD GREENVILLE COLUMBUS GULFPORT MADISON MCCOMB GULFPORT D'IBERVILLE MENDENHALL JACKSON BILOXI TUPELO VICKSBURG JACKSON TUPELO JACKSON JACKSON MOOREVILLE JACKSON

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

2

12:11:22 PM

Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

08956278 1194344838 ADAMS, TRENT E DO

03505511 1578141131 ADAMS, WILLIAM A MD

06425360 1851841548 ADCOCK, DOROTHY L FNP

09289797 1407018302 ADCOCK, MICHAEL A MD

00779068 1659791861 ADDAE, LEONARD MD

00116199 1396816989 ADDISON, HOLLAND M MD

02058301 1205298502 ADEBAYO, AKEEM A MD

03402301 1871023093 ADEBISI, KEHINDE MD

00909884 1770842130 ADEFISAYO, ADERONKE MD

00253023 1649213455 ADELEYE, JAIYEOLA O MD

08254310 1225379050 ADELEYE, OLAMIDE O NP

06180721 1073567251 ADELEYE, OLUFEMI O

00123002 1700805363 ADEN, LESLIE B MD

03637292 1982950937 ADEPOJU, OLUWAROTIMI A MD

00121344 1861414708 ADESOJI, GAFAR A MD

00121343 1043232986 ADESOJI, REMILEKUN S

01173517 1639631864 ADEYEMI, BABATUNDE K DO

07479081 1356961437 ADEYEMI, ELIZABETH I D.O.

01808768 1457731861 ADHIKARI, SUBODH MD

04281720 1922521103 ADKINS, COURTNEY T NP

06902563 1568563385 ADKINS, JONATHAN R MD

00032255 1376019471 ADKINS, SONYA R NP

00113910 1629056502 ADKINS, TODD N MD

00454212 1386630911 ADKINS, WILLIAM B MD

00060334 1124239504 ADKINS, WILLIAM M DMD

05555520 1356550594 ADLAKHA, SATJIT DO

06628859 1891360384 ADLY, KIROLOS D.O.

09723831 1568604569 ADMIRE, BEAU D MD

CITY JACKSON JACKSON JACKSON FLOWOOD NACHEZ JACKSON HATTIESBURG GREENVILLE CLARKSDALE CLARKSDALE SOUTHAVEN SOUTHAVEN FLOWOOD PEARL SOUTHAVEN SOUTHAVEN JACKSON JACKSON HATTIESBURG MERIDIAN JACKSON NEW ALBANY OXFORD SOUTHAVEN MACON PASCAGOULA WHITFIELD GULFPORT

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

3

12:11:22 PM

Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

08958249 1770873093 AFSHAN, SABAHAT MD

02437244 1730377607 AGANS, STEPHEN C MD

05338018 1245889807 AGENT, JAMIE FNP

00150271 1871805820 AGENT, KIMBERLY C FNP-C

02432061 1316154974 AGGARWAL, AVICHAL MD

02926008 1730520768 AGHA, AHMAD MD

04475870 1790197416 AGNEW, SHAWANDA N MD

05029265 1184853913 AGRAWAL, KHUSHBOO MD

09538224 1285897553 AGUILAR DUENAS, SANTIAGO MD

07225310 1831776533 AGUM, NNEKA MD

04608247 1962856419 AHLUWALIA, SAHIBA B MD

01283899 1811574494 AHMAD, MOHSIN M MD

07309879 1679192165 AHMAD, OMAMA M.D.

00118561 1275516387 AHMAD, RAFIQUE MD

00115474 1235111592 AHMAD, RAZEE A

01702234 1568781144 AHMAD-SABRY, MOHAMMAD MD

09186581 1447879937 AHMED, HAFSAH MD

02934383 1043743339 AHMED, HIBA Z MD

00124344 1255435889 AHMED, ISRAR MD

00119831 1861458762 AHMED, MOHAMMAD A

09432818 1134339286 AHUJA, MOHIT MD

06120550 1578904199 AHUJA, SHRADHA MD

07036868 1467804476 AINSWORTH, JACQUELYN R FNP

03850930 1346790417 AINSWORTH, JENNA

03632755 1356900534 AINSWORTH, SEREN E FNP-C

04576536 1982877551 AITKEN, EMEM J MD

01783376 1982632063 AJAGBE, OLUKUNLE A MD

08329730 1366071870 AKALONU, CHIBUZO M.D.

CITY JACKSON GULFPORT PHILADELPHIA CARTHAGE JACKSON BILOXI CLARKSDALE TUPELO SOUTHAVEN JACKSON BAY ST LOUIS HATTIESBURG JACKSON MERIDIAN MERIDIAN AMORY JACKSON JACKSON WINONA GREENVILLE FLOWOOD JACKSON MARKS FLOWOOD BILOXI JACKSON MCCOMB JACKSON

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

4

12:11:22 PM

Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

09109011 1528409018 AKAM VENKATA, JYOTHSNA M.D.

00116916 1851411425 AKERS, PAULA S NP

04138075 1528371978 AKHARUME, EHIDANMEGBE O DDS

00727322 1154819134 AKHLAQ, ANUM M.D.

00110567 1679647754 AKIN, CAROL MD

00660340 1487750832 AKIN, RICHARD R DMD

06403709 1215022694 AKINWALE, AKINREMI A M.D.

07109304 1164047197 AKRIDGE, ALLISON DO

00783021 1720619083 AKRIDGE, LISA NP

02902345 1447379300 AL GODI, ZHEAR MD

09384361 1295151801 AL HMADA, YOUSSEF MD

02726844 1669963518 AL-FADHLI, FAHAD DMD

01720218 1083297535 AL-FARAJ, NADA MD

05375374 1821453648 ALABI, OLAMIDE S NP

05824814 1356761597 ALAM, OSCAR MD

00118541 1891767687 ALBERS, TIMOTHY A

00018403 1679562094 ALBERT, MICHAEL H MD

09326201 1902317969 ALBIN, JENNIFER NP

05189360 1942678875 ALBONETTI, NICHOLAS FNP

00806548 1043773815 ALBRECHT, DANA H NP

05259761 1962539577 ALBRECHT, SVENJA J MD

00019708 1053373316 ALBRIGHT, ANTHONY MD

00975298 1376187799 ALBRITTON, DAVID C CFNP

01872798 1053992511 ALBURY, COURTNEY N DO

03222340 1669760021 ALCIVAR FRANCO, DIEGO F MD

00601500 1437413770 ALDERMAN III, JOSHUA C NP

09656751 1013234137 ALDERS, MICHELLE DO

06487860 1659330231 ALDINGER, SEAN OD

CITY JACKSON OXFORD RIDGELAND JACKSON OLIVE BRANCH HAZLEHURST NATCHEZ WAYNESBORO WAYNESBORO AMORY JACKSON HATTIESBURG HATTIESBURG TUPELO JACKSON TUPELO RICHLAND FLOWOOD SOUTHAVEN DIAMONDHEAD JACKSON PICAYUNE COLUMBIA HATTIESBURG HATTIESBURG WIGGINS MERIDIAN OLIVE BRANCH

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

5

12:11:22 PM

Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

02504301 1720428121 ALDRED, LEWIS W MD

00123127 1427148667 ALDRIDGE, EDWARD F M.D.

00125563 1508815713 ALDRIDGE, MARCENIA

00123692 1336145770 ALEXANDER III, RICHMOND L MD

09136733 1104198266 ALEXANDER, AMIE L NP-C

01881821 1760901649 ALEXANDER, ANDREA J NP

00119465 1083661946 ALEXANDER, BELINDA B MD

00126950 1790828580 ALEXANDER, BETTY JO CPNP

07230249 1174815609 ALEXANDER, CATHERINE A MD

04828561 1962716894 ALEXANDER, KATHRYN C FNP-C

07356036 1104277136 ALEXANDER, KELLY P NP

04626507 1780881128 ALEXANDER, LAURA E D.O.

00115251 1285648063 ALEXANDER, MYRNA E MD

00538227 1356979843 ALEXANDER, NATHAN W M.D.

00188545 1972739837 ALEXANDER, SURESH M MD

03028562 1699956318 ALEXANDER, TERESA G APRN

00118702 1861416042 ALEXIS, KATHERINE P

02421091 1417148891 ALFARIS, MOHAMED MD

00116392 1639261597 ALFORD, DONNA L CNP

02853240 1821678160 ALFORD, MARY M MD

00115762 1023070067 ALFORD, TIMOTHY J MD

00064988 1174653737 ALFORD, WILLIAM L DDS

05324298 1770848434 ALGEE, LINDSEY E NP

00114335 1164468468 ALI, JEFFREY A MD

06225261 1679759898 ALI, MOHAMMAD A MD

07829791 1184079246 ALI, NABEEL S MD

09233520 1023427481 ALI, NASEEM D NP

00114254 1649297201 ALI, RASHAD N MD

CITY HATTIESBURG OCEAN SPRINGS MCCOMB MERIDIAN GULFPORT JACKSON BILOXI PICAYUNE SOUTHAVEN JACKSON JACKSON MERIDIAN JACKSON JACKSON JACKSON MERIDIAN HATTIESBURG NATCHEZ CHOCTAW JACKSON KOSCIUSKO SENATOBIA RIPLEY JACKSON JACKSON SOUTHAVEN SOUTHAVEN LAUREL

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

6

12:11:22 PM

Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

00121559 1497735039 ALI, RONNIE DO

01289552 1801989124 ALI, SALEEM A MD

00853827 1033748843 ALI, YEHIA

03052317 1164050399 ALIAKBARIAN, HASSAN MD

06184898 1801350582 ALISON, MARY JO A NP

06889747 1821684838 ALISON, MONICA L NP

06554886 1316315823 ALKHATIB, MOHAMMAD MD

06728529 1487148987 ALKOFAHI, ALA MD

99999998

ALL NINES, PROVIDER

01999999

ALL NINES, PROVIDER

05188833 1700016763 ALLA, SRIDEVI MD

09676261 1477667327 ALLBRIGHT, ROBERT M MD

00238224 1295281384 ALLDREAD, JESSICA H FNP-C

00015062 1295702595 ALLEN JR., RAY M MD

01387250 1568921245 ALLEN RYDBECK, RACHEL E NP

05976701 1295353290 ALLEN, ASHLEY NP-C

08178819 1073091963 ALLEN, BRANDON NP

09686835 1770923815 ALLEN, BRIDGER DMD

00120124 1679668487 ALLEN, CYNTHIA E MD

09870004 1154531234 ALLEN, DUSTIN S MD

08287001 1184946170 ALLEN, ELIZABETH CFNP

07077024 1659918084 ALLEN, ELIZABETH FNP

05001549 1417275652 ALLEN, JOHN C MD

00124398 1801868666 ALLEN, JOHN W

01988297 1073132783 ALLEN, JOSHUA R D.O.

00320511 1174803829 ALLEN, MARIE FNP

06733243 1710217914 ALLEN, PENNIE L

01283342 1750398038 ALLEN, ROBIN M NP

CITY GULFPORT TUPELO JACKSON HATTIESBURG GULFPORT GULFPORT OXFORD OXFORD RIDGELAND RIDGELAND JACKSON JACKSON GRENADA SOUTHAVEN GULFPORT RICHLAND MERIDIAN HORN LAKE FLOWOOD MERIDIAN CLINTON HATTIESBURG HATTIESBURG OLIVE BRANCH JACKSON JACKSON HATTIESBURG GULFPORT

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

7

12:11:22 PM

Report: RP126

Envision

Provider Subsystem

Mississippi Division of Medicaid

PRESCRIBING PROVIDER LISTING FOR THE STATE OF MISSISSIPPI

Run Date: 1/9/2022 Run Time: 12:11 PM

PROVIDER ID NPI

PROVIDER NAME

09689701 1730491036 ALLEN, SUMMER L MD

06073789 1225532450 ALLEN, TABITHA N FNP

06600273 1295009330 ALLEN, TARA J MSN

06632203 1417945932 ALLEN, TIMOTHY C MD

03189253 1346318011 ALLEN, WILLIAM MD

05934884 1952863185 ALLEN, WILLIAM T MD

05934884 1952863185 ALLEN, WILLIAM T MD

09337556 1457582629 ALLEYNE, PAUL MD

00150706 1124374673 ALLGOOD, MARGARET T FNP

02600861 1790104297 ALLISON, CHRISTIAN A NP-C

05753574 1538377981 ALLISON, SHELTON MD

02452339 1194256537 ALLISON, TIFFANY M DO

04387711 1528248960 ALLMAN, RUSSELL E MD

04501136 1275145781 ALLRED, AMANDA NP

05821751 1679018410 ALLRED, CASSIE B PA-C

06000736 1447514914 ALLRED, LINDSEY H MD

09505243 1942395371 ALLRED, WILLIAM T MD

00118107 1548217904 ALMAND, JEFF D MD

07087229 1396992244 ALMON, WENDY R DMD

00933523 1023458395 ALMONTE, GERMAN A MD

00984324 1215960786 ALNAS, WAIL MD

04307288 1669902615 ALOTAIBI, FAWWAZ F BDS

07539809 1386926434 ALRIDGE, GLORIA NP

09832808 1285014613 ALSATLI, AMRULLAH R MD

00126535 1023073251 ALSHEIKH, NABIH

07834819 1659764041 ALTAMIRANO, JOHN-MARIO W FNP

06282515 1124284427 ALTERMAN, DANIEL MD

04204590 1295085892 ALTHEEB, ZAID F MD

CITY GULFPORT VICKSBURG JACKSON JACKSON GREENWOOD JACKSON MERIDIAN JACKSON AMORY GUNTOWN HATTIESBURG JACKSON GULFPORT STARKVILLE NEW ALBANY JACKSON SOUTHAVEN JACKSON LIBERTY PICAYUNE COLUMBUS LAUREL LAUREL HATTIESBURG HATTIESBURG MERIDIAN SOUTHAVEN MERIDIAN

STATE MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

Jan 9, 2022

8

12:11:22 PM

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