NPIMap

Organization Active NPI

Conrad Pearson Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Southaven, MS
National Provider Identifier
1154173102
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
CONRAD PEARSON CLINIC PC
Practice address
125 Guthrie Dr Ste 100
Southaven, MS 38671-5829
Phone
(662) 349-1964
NPI assigned
Apr 3, 2024
Last updated
Jun 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CONRAD PEARSON CLINIC PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Authorized official

Name
Paul Eber, MDNPI 1124085634
Title
Authorized Official
Phone
(901) 252-3411

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

125 Guthrie Dr Ste 100
Southaven, MS 38671-5829

Mailing address

125 Guthrie Dr Ste 100
Southaven, MS 38671-5829
Phone (662) 349-1964

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240724000795 MS DME Supplier - Physician - Urology 7315832649 Practice locations: Southaven, MS

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
The Conrad Pearson Clinic P2 organizations share this tax ID, including this one
Part of
The Conrad Pearson Clinic P

Other organizations with this tax ID 1

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

Locations

125 Guthrie Dr
Ste 100
Southaven, MS 38671
Phone (662) 349-1964

Practitioners & affiliated clinicians

Practitioners 1

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": "1712102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1154173102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 GUTHRIE DR STE 100",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715829",
            "telephone_number": "662-349-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 GUTHRIE DR STE 100",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715829",
            "telephone_number": "662-349-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONRAD PEARSON CLINIC PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONRAD PEARSON CLINIC PC",
        "enumeration_date": "2024-04-03",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "EBER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "901-252-3411",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30.8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.