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CODY WAYNE CISSOM D.O.
NPI 1104511153
Internal Medicine in Tupelo, MS

Active since April 06, 2023PECOS Enrolled
830 S GLOSTER ST, TUPELO, MS 38801(662) 377-3000 Get Directions Write a Review

NPPES record last updated: April 6, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Cody Wayne Cissom D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CODY WAYNE CISSOM D.O. (NPI 1104511153) is an individual internal medicine provider in Tupelo, Mississippi, licensed in Mississippi (PENDING) and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104511153
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameCODY WAYNE CISSOMCredential: D.O.
Location Address830 S GLOSTER STTupelo, MS 38801-4996
Mailing Address830 S Gloster StTupelo, MS 38801-4996 · (662) 377-3000
Phone(662) 377-3000
Sole ProprietorNo
Enumeration DateApril 6, 2023
NPPES CertifiedMarch 26, 2023
✔ NPI 1104511153 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MS · PENDING
Definition
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.
830 S GLOSTER ST, Tupelo, MS 38801
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cody Wayne Cissom D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 38801 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$120.41 typical visit price
range $51.65 – $159.18
Typical copayment $30.10 (range $12.91 – $39.79)
Most-billed visit code 99204
Established Patient
$92.20 typical visit price
range $16.15 – $129.61
Typical copayment $23.05 (range $4.03 – $32.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAUREN ELIZABETH ABEL CRNA
Nurse Anesthetist, Certified Registered
830 S GLOSTER ST
TUPELO, MS 38801
Lee County (662) 377-4394
WESLEY B BRUCE
Nurse Practitioner (Family)
830 S GLOSTER ST
TUPELO, MS 38801
Lee County (662) 377-3000
DR. ROBERT CARSON KIRKSEY M.D.
Emergency Medicine
830 S GLOSTER ST
TUPELO, MS 38801
Lee County (866) 754-3852
NORTH MISSISSIPPI MEDICAL CENTER SERVICES LLC
Internal Medicine
830 S GLOSTER ST
TUPELO, MS 38801
Lee County (662) 377-4685
NORTH MISSISSIPPI MEDICAL CENTER INC
Thoracic Surgery (Cardiothoracic Vascular Surgery)
830 S GLOSTER ST, 4TH FLOOR EAST TOWER
TUPELO, MS 38801
Lee County (662) 377-7170
JENNIFER L TAYLOR FNP-BC
Nurse Practitioner (Family)
830 S GLOSTER ST
TUPELO, MS 38801
Lee County (205) 412-0585
KALISA MICKELL FNP
Nurse Practitioner (Family)
830 S GLOSTER ST
TUPELO, MS 38801
Lee County (662) 377-3000
JESSICA KATHRYN PIPPIN
Nurse Practitioner
830 S GLOSTER ST
TUPELO, MS 38801
Lee County (888) 731-7611

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cody Cissom's NPI number?

The NPI number for Cody Cissom is 1104511153. It was assigned to this individual provider in the NPPES registry on April 6, 2023.

Where is Cody Cissom located?

Cody Cissom practices at 830 S Gloster St, Tupelo, MS 38801. The listed phone number is (662) 377-3000.

What is Cody Cissom's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Cody Cissom enrolled in Medicare?

Yes. Cody Cissom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Cody Cissom was last updated on April 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.