NPIMap

Organization Active NPI

Hogan Surgical Center PA

Doing business as Souhern Vision Surgery Center Gulfport

  • Ambulatory Surgical Clinic/Center
  • Gulfport, MS
National Provider Identifier
1104829597
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
25C0001038 Issued in MS
Legal business name
HOGAN SURGICAL CENTER PA
Doing business as
Souhern Vision Surgery Center Gulfport
Southern Vision Surgery Center
Practice address
351 Cowan Rd
Gulfport, MS 39507-2019
Phone
(228) 896-1120
Fax
(228) 896-1332
NPI assigned
May 31, 2005
Last updated
Feb 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Authorized official

Name
Dr. Kiper C Nelson, MDNPI 1548263312
Title
Owner
Phone
(228) 896-1120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 25C0001038 MS Primary

Addresses

Primary practice location

351 Cowan Rd
Gulfport, MS 39507-2019

Mailing address

351 Cowan Rd
Gulfport, MS 39507-2019
Phone (228) 896-1120

Other identifiers 1

IdentifierTypeStateIssuer
00770572MedicaidMS

Other names 2

  • Souhern Vision Surgery Center Gulfport Doing business as
  • Southern Vision Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070516000184 MS Part B Supplier - Ambulatory Surgical Center 4880791490 Receives reassigned benefits from 5 practitioners
Practice locations: Gulfport, MS
O20070618000014 MS Part B Supplier - Clinic/Group Practice 4880791490 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
Practice locations: Gulfport, MS

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
Crna Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1104829597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 COWAN RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395072019",
            "telephone_number": "228-896-1120",
            "fax_number": "228-896-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 COWAN RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395072019",
            "telephone_number": "228-896-1120",
            "fax_number": "228-896-1332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOGAN SURGICAL CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KIPER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-896-1120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MS",
            "license": "25C0001038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770572",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Souhern Vision Surgery Center Gulfport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Vision Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; 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.