NPIMap

Individual provider Active NPI

Berthold Beisel, MD

  • Family Medicine Physician
  • Columbia, MS
National Provider Identifier
1174546345
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17957 Issued in MS
Practice address
502 Broad St
Columbia, MS 39429-3037
Phone
(601) 736-8282
Fax
(601) 736-8333
NPI assigned
Jul 26, 2006
Last updated
Aug 23, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17957 MS Primary

Addresses

Primary practice location

502 Broad St
Columbia, MS 39429-3037

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 736-8282

Other identifiers 4

IdentifierTypeStateIssuer
1739685MedicaidLA
P00007519OtherRAILROAD MEDICARE
03871775MedicaidMS
640507572TLOtherMSAMERICAN ADMIN GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071212000061 MS Practitioner - Family Practice 4082704291 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forrest County General HospitalGroup PAC ID 1052397767, 107 clinicians

Practice addresses (Care Compare)

1560 Sumrall Rd
Columbia, MS 39429-2654
Phone (601) 736-6303

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Oct 1, 2021 Accepting new patients
Forrest General Hospital CurrentSince Oct 1, 2021 Accepting new patients
Forrest County General Hospital Current Accepting new patients
The Clinic at Farmers Medshoppe CurrentSince Mar 1, 2017 Accepting new patients
Forrest County General Hospital Past Accepting new patients

Locations

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

62 Highway 587
Foxworth, MS 39483
Phone (601) 424-3540

125 S 28th Ave
Ste 326
Hattiesburg, MS 39401

2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

415 S 28th Ave
Fl 1
Hattiesburg, MS 39401
Phone (601) 288-5200

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471910400000",
    "number": "1174546345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-736-8282",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 BROAD ST",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293037",
            "telephone_number": "601-736-8282",
            "fax_number": "601-736-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEISEL",
        "first_name": "BERTHOLD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2016-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "17957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1739685",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00007519",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03871775",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ADMIN GROUP",
            "identifier": "640507572TL",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MS

Sources for this page

Verify at the official NPI Registry.