NPIMap

Organization Active NPI

The National Diabetes & Obesity Research Institute at Tradition, Missi

  • Endocrinology, Diabetes & Metabolism Physician
  • Biloxi, MS
National Provider Identifier
1003397530
Registry record updated Oct 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
THE NATIONAL DIABETES & OBESITY RESEARCH INSTITUTE AT TRADITION, MISSI
Practice address
19289 St. Joseph Street
Suite C
Biloxi, MS 39532
Phone
(228) 831-8764
Fax
(228) 233-1252
NPI assigned
Aug 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2018

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

Authorized official

Name
Dr. Peter J. Fos, PH.D, D.D.S., M.P.H
Title
Executive Director
Phone
(228) 831-8764

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

19289 St. Joseph Street
Suite C
Biloxi, MS 39532

Mailing address

19289 St. Joseph Street
Suite C
Biloxi, MS 39532
Phone (228) 831-8764

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181113000364 MS Part B Supplier - Clinic/Group Practice 6103170006 Receives reassigned benefits from 8 practitioners
Practice locations: Biloxi, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539820800000",
    "number": "1003397530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19289 ST. JOSEPH STREET",
            "address_2": "SUITE C",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "39532",
            "telephone_number": "228-831-8764",
            "fax_number": "228-233-1252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19289 ST. JOSEPH STREET",
            "address_2": "SUITE C",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "39532",
            "telephone_number": "228-831-8764",
            "fax_number": "228-233-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE NATIONAL DIABETES & OBESITY RESEARCH INSTITUTE AT TRADITION, MISSI",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-23",
        "last_updated": "2018-10-18",
        "status": "A",
        "authorized_official_last_name": "FOS",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "228-831-8764",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D, D.D.S., M.P.H"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.