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Organization Active NPI

Kings Daughters Medical Center

Doing business as Kings Daughters Pro Anesthesia

  • Anesthesiology Physician
  • Brookhaven, MS
National Provider Identifier
1043245368
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
KINGS DAUGHTERS MEDICAL CENTER
Doing business as
Kings Daughters Pro Anesthesia
Practice address
427 Highway 51 N
Brookhaven, MS 39601-2350
Phone
(601) 835-9275
Fax
(601) 833-2791
NPI assigned
Jul 12, 2006
Last updated
Mar 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Authorized official

Name
Scott Christensen
Title
Ceo
Phone
(601) 835-9488

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary
Certified Registered Nurse Anesthetist 367500000X NU

Addresses

Primary practice location

427 Highway 51 N
Brookhaven, MS 39601-2350

Mailing address

PO Box 1547
Sedalia, MO 65302-1547
Phone (660) 826-5960

Other identifiers 1

IdentifierTypeStateIssuer
09013695MedicaidMS

Other names 1

  • Kings Daughters Pro Anesthesia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041028000174 MS Part B Supplier - Clinic/Group Practice 3072575539 Receives reassigned benefits from 149 practitioners
1 other NPI on this enrollment
Practice locations: Brookhaven, MS

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Kings Daughters Hosp Su11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
King's Daughters Medical ClinicBrookhaven, MS, CCN 258676 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 2024
Jan 1, 2024
King's Daughters Primary Care ClinicBrookhaven, MS, CCN 258678 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 2024
Jan 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 157

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 157

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1043245368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021547",
            "telephone_number": "660-826-5960",
            "fax_number": "660-826-4852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 HIGHWAY 51 N",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012350",
            "telephone_number": "601-835-9275",
            "fax_number": "601-833-2791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGS DAUGHTERS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-835-9488"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013695",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kings Daughters Pro Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kings Daughters Pro Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookhaven, MS

Sources for this page

Verify at the official NPI Registry.