NPIMap

Organization Active NPI

Southwest Mississippi Regional Medical Center

Doing business as Cardiovascular Institute of Mississippi

  • Vascular Surgery Physician
  • McComb, MS
National Provider Identifier
1124077581
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
Doing business as
Cardiovascular Institute of Mississippi
Practice address
303 Marion Ave
McComb, MS 39648-2707
Phone
(601) 249-1350
Fax
(601) 249-1339
NPI assigned
May 10, 2006
Last updated
Nov 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Authorized official

Name
Mrs. Charla Rowley
Title
Ceo
Phone
(601) 249-1806

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

303 Marion Ave
McComb, MS 39648-2707

Mailing address

PO Box 490
McComb, MS 39649-0490
Phone (601) 249-2701

Other identifiers 1

IdentifierTypeStateIssuer
09015786MedicaidMS

Other names 1

  • CARDIOVASCULAR INSTITUTE OF MISSISSIPPI Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080512000004 MS Part B Supplier - Clinic/Group Practice 5193633907 Receives reassigned benefits from 86 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McComb, MS; Summit, MS; Monticello, MS

Other NPIs on the same Medicare enrollment 22

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

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Smrmc Dba SW Internal M34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Locations

1318 Harrison Ave
McComb, MS 39648
Phone (601) 684-2300

Practitioners & affiliated clinicians

Practitioners 9

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": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1124077581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396490490",
            "telephone_number": "601-249-2701",
            "fax_number": "601-249-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 MARION AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482707",
            "telephone_number": "601-249-1350",
            "fax_number": "601-249-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "ROWLEY",
        "authorized_official_first_name": "CHARLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-249-1806",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015786",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CARDIOVASCULAR INSTITUTE OF MISSISSIPPI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CARDIOVASCULAR INSTITUTE OF MISSISSIPPI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McComb, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; 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.