NPIMap

Organization Active NPI

Southern Bone & Joint Specialists, PA

  • Orthopaedic Surgery Physician
  • Picayune, MS
National Provider Identifier
1184965170
Registry record updated Mar 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SOUTHERN BONE & JOINT SPECIALISTS, PA
Practice address
128 Highland Pkwy
Suite 100
Picayune, MS 39466-5577
Phone
(601) 554-7400
Fax
(601) 554-7499
NPI assigned
Mar 15, 2013
Last updated
Mar 15, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN BONE & JOINT SPECIALISTS, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2013

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

Authorized official

Name
Mr. David M Burckel
Title
Ceo
Phone
(601) 554-7449

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

128 Highland Pkwy
Suite 100
Picayune, MS 39466-5577

Mailing address

3688 Veterans Memorial Dr
Suite 200
Hattiesburg, MS 39401-8246
Phone (601) 554-7400

Other identifiers 1

IdentifierTypeStateIssuer
09015183MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150409000705 MS DME Supplier - Physician - General Practice 1254328818 Practice locations: Picayune, MS

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Rocco a Barbieri7 organizations share this tax ID, including this one
Part of
Rocco a Barbieri

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1363305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363305600000",
    "number": "1184965170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3688 VETERANS MEMORIAL DR",
            "address_2": "SUITE 200",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018246",
            "telephone_number": "601-554-7400",
            "fax_number": "601-554-7499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 HIGHLAND PKWY",
            "address_2": "SUITE 100",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394665577",
            "telephone_number": "601-554-7400",
            "fax_number": "601-554-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BONE & JOINT SPECIALISTS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN BONE & JOINT SPECIALISTS, PA",
        "enumeration_date": "2013-03-15",
        "last_updated": "2013-03-15",
        "status": "A",
        "authorized_official_last_name": "BURCKEL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-554-7449",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015183",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Picayune, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2013; 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.