Azingala Ajua Fondong, MD - Medicare Emergency Medicine in Tupelo, MS

Azingala Ajua Fondong, MD is a medicare enrolled "Emergency Medicine" physician in Tupelo, Mississippi. His current practice location is 830 S Gloster St, Tupelo, Mississippi. You can reach out to his office (for appointments etc.) via phone at (601) 260-6486.

Azingala Ajua Fondong is licensed to practice in Mississippi (license number 30382) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1154882702.

Contact Information

Azingala Ajua Fondong, MD
830 S Gloster St,
Tupelo, MS 38801-4934
(601) 260-6486
Not Available



Physician's Profile

Full NameAzingala Ajua Fondong
GenderMale
SpecialityEmergency Medicine
Location830 S Gloster St, Tupelo, Mississippi
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1154882702
  • Provider Enumeration Date: 03/27/2019
  • Last Update Date: 04/18/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 9537545587
  • Enrollment ID: I20220929000505

Medical Identifiers

Medical identifiers for Azingala Ajua Fondong such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1154882702NPI-NPPES
1154882702MedicaidTN

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine 30382 (Mississippi)Secondary
390200000XStudent In An Organized Health Care Education/training Program (* (Not Available))Secondary
207P00000XEmergency Medicine 30382 (Mississippi)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Azingala Ajua Fondong allows following entities to bill medicare on his behalf.
Entity NamePontotoc Health Services, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1821103516
PECOS PAC ID: 6002895356
Enrollment ID: O20040719001336

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Entity NameSoutheastern Emergency Physicians Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1356379382
PECOS PAC ID: 2466364997
Enrollment ID: O20050407000866

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Entity NameRelias Emergency Medicine Specialists Of Tupelo Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1841664661
PECOS PAC ID: 6608179734
Enrollment ID: O20160125001174

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Entity NameRelias Hospitalist Medicine Specialists Of Pontotoc Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1972189330
PECOS PAC ID: 0143629592
Enrollment ID: O20210604001444

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Azingala Ajua Fondong is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Azingala Ajua Fondong, MD
3400 Mccullough Blvd Apt 712,
Belden, MS 38826-9466

Ph: () -
Azingala Ajua Fondong, MD
830 S Gloster St,
Tupelo, MS 38801-4934

Ph: (601) 260-6486

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Emergency Medicine Doctors in Tupelo, MS

Dr. Robert Carson Kirksey, M.D.
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 830 S Gloster St, Tupelo, MS 38801
Phone: 866-754-3852    Fax: 205-313-5245
Donna B. Pritchard, NP
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 830 S. Gloster St., Tupelo, MS 38801
Phone: 800-893-9698    
William M Kirksey, M.D.
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 830 S Gloster St, Tupelo, MS 38801
Phone: 866-754-3852    Fax: 205-313-5245
Dr. Buford L Lambert, MD
Emergency Medicine
Medicare: Medicare Enrolled
Practice Location: 5221b Cliff Gookin Blvd, Tupelo, MS 38801
Phone: 662-620-8123    Fax: 662-620-8131
Dr. Clarence A Justice, MD
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 589 Garfield St, Suite 201, Tupelo, MS 38801
Phone: 662-680-5565    Fax: 662-680-5654
John A Cantrell, M.D.
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 830 S Gloster St, Tupelo, MS 38801
Phone: 866-754-3852    Fax: 205-313-5245
Genti Tahiraj, M.D.
Emergency Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 830 S Gloster St, Tupelo, MS 38801
Phone: 615-477-8401    

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