Greenville Surgical Clinic

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

1601 Issued in MS

Legal business name

GREENVILLE SURGICAL CLINIC

Doing business as

Greenville Surgical clinic

Practice address

1214 Hospital St
Greenville, MS 38703-3213

Phone

(662) 335-9283

Fax

(662) 334-6989

NPI assigned

Apr 3, 2007

Last updated

Aug 10, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Philip D Doolittle, MDNPI 1104925148

Title

Owner

Phone

(662) 335-9283

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Greenville Surgical clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/6af660a6-1deb-4c41-a9ac-8c8750f37b1d/

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Philip D Doolittle, MD

  • Surgery Physician
  • Greenville, MS
  • NPI 1104925148
  Medicare reassignment NPD Authorized official
• Jeffery Samuel Doolittle, M.D.

  • Surgery Physician
  • Greenville, MS
  • NPI 1932252954
  Medicare reassignment NPD
• Renia R Dotson, MD

  • Colon & Rectal Surgery Physician
  • Greenville, MS
  • NPI 1205935269
  NPD (past)
• Debra Peden, CRNFA

  • Registered Nurse First Assistant
  • Greenville, MS
  • NPI 1902135536
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249862400000",
    "number": "1013038330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4499",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387044499",
            "telephone_number": "662-335-9283",
            "fax_number": "662-334-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1214 HOSPITAL ST",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387033213",
            "telephone_number": "662-335-9283",
            "fax_number": "662-334-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE SURGICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2009-08-10",
        "status": "A",
        "authorized_official_last_name": "DOOLITTLE",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-335-9283",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MS",
            "license": "1601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07975534",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenville Surgical clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jalisa R Greer, M.S.,CCC-SLP
• Gail L Griffin
• Mary Lord Griffin, O.D.
• Brandi Dawn Grothman

• Surgery Physician in Greenville, MS
• Providers in Greenville, MS by specialty
• Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2009; 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.