NPIMap

Organization Active NPI

Gastrointestinal Associates, P.a.

  • Gastroenterology Physician
  • Vicksburg, MS
National Provider Identifier
1144412438
Registry record updated Dec 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROINTESTINAL ASSOCIATES, P.A.
Practice address
1815 Mission 66
Vicksburg, MS 39180-3709
Phone
(601) 355-1234
Fax
(601) 326-3566
NPI assigned
Aug 10, 2007
Last updated
Dec 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
GASTROINTESTINAL ASSOCIATES, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2016

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

Authorized official

Name
Pierce D Dotherow, M.D.NPI 1346238615
Title
Authorized Official
Phone
(601) 355-1234

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary
Pediatric Gastroenterology Physician 2080P0206X NU

Addresses

Primary practice location

1815 Mission 66
Vicksburg, MS 39180-3709

Mailing address

2510 Lakeland Dr
Flowood, MS 39232-9513
Phone (601) 355-1234

Other identifiers 1

IdentifierTypeStateIssuer
09852713MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041013001263 MS Part B Supplier - Clinic/Group Practice 5294795241 Receives reassigned benefits from 108 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Flowood, MS; Hattiesburg, MS; Madison, MS; Vicksburg, MS

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Gastronintestinal Assoc8 organizations share this tax ID, including this one
Part of
Gastronintestinal Assoc

Other organizations with this tax ID 7

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

100 Methodist Hospital Blvd
Hattiesburg, MS 39402
Phone (601) 268-5185

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480982400000",
    "number": "1144412438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 LAKELAND DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329513",
            "telephone_number": "601-355-1234",
            "fax_number": "601-326-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803709",
            "telephone_number": "601-355-1234",
            "fax_number": "601-326-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROINTESTINAL ASSOCIATES, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTROINTESTINAL ASSOCIATES, P.A.",
        "enumeration_date": "2007-08-10",
        "last_updated": "2016-12-06",
        "status": "A",
        "authorized_official_last_name": "DOTHEROW",
        "authorized_official_first_name": "PIERCE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "601-355-1234",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09852713",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

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

Verify at the official NPI Registry.