NPIMap

Organization Active NPI

South Mississippi Regional Center

  • Intellectual Disabilities Intermediate Care Facility
  • Long Beach, MS
National Provider Identifier
1033143284
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
311 Issued in MS
Legal business name
SOUTH MISSISSIPPI REGIONAL CENTER
Practice address
1170 W Railroad St
Long Beach, MS 39560-4106
Phone
(228) 867-1300
Fax
(228) 214-5563
NPI assigned
Jul 11, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Pamela Baker, PHD
Title
Director of Facility
Phone
(228) 867-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 311 MS Primary

Addresses

Primary practice location

1170 W Railroad St
Long Beach, MS 39560-4106

Mailing address

1170 W Railroad St
Long Beach, MS 39560-4106
Phone (228) 867-1300

Other identifiers 5

IdentifierTypeStateIssuer
00021842MedicaidMS
09555710MedicaidMS
00770072MedicaidMS
00095206MedicaidMS
09015481MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
South Mississippi Regional Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033143284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 W RAILROAD ST",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395604106",
            "telephone_number": "228-867-1300",
            "fax_number": "228-214-5563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 W RAILROAD ST",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395604106",
            "telephone_number": "228-867-1300",
            "fax_number": "228-214-5563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MISSISSIPPI REGIONAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "DIRECTOR OF FACILITY",
        "authorized_official_telephone_number": "228-867-1300",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MS",
            "license": "311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00021842",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09555710",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770072",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00095206",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015481",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.