NPIMap

Organization Active NPI

Good Samaritan Physical Therapy,Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Vicksburg, MS
National Provider Identifier
1023087855
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
GOOD SAMARITAN PHYSICAL THERAPY,INC.
Practice address
1901 Mission 66
Suite a
Vicksburg, MS 39180-3711
Phone
(601) 638-4076
Fax
(601) 638-4979
NPI assigned
Mar 15, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Fermika Smith
Title
Billing Manager
Phone
(601) 638-4076

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X MS Primary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Customized Equipment (DME) 332BC3200X NU
Nursing Facility Supplies (DME) 332BN1400X NU
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X NU
Oxygen Equipment & Supplies (DME) 332BX2000X NU

Addresses

Primary practice location

1901 Mission 66
Suite a
Vicksburg, MS 39180-3711

Mailing address

PO Box 822394
Vicksburg, MS 39182-2394
Phone (601) 638-4076

Other identifiers 7

IdentifierTypeStateIssuer
5429586OtherMSAETNA PROVIDER NUMBER
000050976OtherMSBLUE CROSS NUMBER
09015117MedicaidMS
1465739MedicaidLA
6430026OtherMSUNITED HEALTH CARE NUMBER
174112500OtherMSOWCP
4253810001OtherMSDME

National Provider Directory

National Provider Directory

Locations

610 Market St
Port Gibson, MS 39150
Phone (601) 437-2399

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1023087855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 822394",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391822394",
            "telephone_number": "601-638-4076",
            "fax_number": "601-638-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MISSION 66",
            "address_2": "SUITE A",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-638-4076",
            "fax_number": "601-638-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN PHYSICAL THERAPY,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "FERMIKA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "601-638-4076",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "MS",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "5429586",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "000050976",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015117",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1465739",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE NUMBER",
            "identifier": "6430026",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "174112500",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "4253810001",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.