Active NPI
George Regional ER Physicians
- Emergency Medical Services (Emergency Medicine) Physician
- Lucedale, MS
National Provider Identifier
1043690936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- Legal business name
- GEORGE REGIONAL ER PHYSICIANS
- Practice address
- 859 Winter St
Lucedale, MS 39452-6603 - Phone
- (601) 947-3161
- Fax
- (601) 947-1331
- NPI assigned
- Jun 4, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Kathy Fender
- Title
- Administrator
- Phone
- (601) 947-8181
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | Primary |
Addresses
Primary practice location
859 Winter St
Lucedale, MS 39452-6603
Mailing address
PO Box 1007
Lucedale, MS 39452-1007
Phone (601) 947-1332
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01839854 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150728006195 | MS | Part B Supplier - Clinic/Group Practice | 6608180138 |
Receives reassigned benefits from 34 practitioners Practice locations: Lucedale, MS |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 34
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Emergency Medical Services (Emergency Medicine) Physician
- Hattiesburg, MS
- NPI 1174517007
Emergency Medical Services, MS
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433376000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1478476800000",
"number": "1043690936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1007",
"city": "LUCEDALE",
"state": "MS",
"postal_code": "394521007",
"telephone_number": "601-947-1332",
"fax_number": "601-947-1331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "859 WINTER ST",
"city": "LUCEDALE",
"state": "MS",
"postal_code": "394526603",
"telephone_number": "601-947-3161",
"fax_number": "601-947-1331"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GEORGE REGIONAL ER PHYSICIANS",
"organizational_subpart": "NO",
"enumeration_date": "2015-06-04",
"last_updated": "2016-11-07",
"status": "A",
"authorized_official_last_name": "FENDER",
"authorized_official_first_name": "KATHY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "601-947-8181",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01839854",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lucedale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; 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.