Active NPI
Tess Maryanne Maubach IX, ATC
- Athletic Trainer
- Hattiesburg, MS
National Provider Identifier
1205559697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 118 College Dr
Hattiesburg, MS 39406-0002 - Phone
- (601) 266-1000
- NPI assigned
- Sep 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Athletic Trainer | 2255A2300X | MS | Primary |
Addresses
Primary practice location
118 College Dr
Hattiesburg, MS 39406-0002
Mailing address
118 College Dr
Hattiesburg, MS 39406-0002
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TEA806249754 | Other | IL | BLUE CROSS & BLUE SHEILD |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | tess.maubach@usm.edu |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Southern Mississippi | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic Pharmacy
- Hattiesburg, MS
- NPI 1750402798
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669680000000",
"number": "1205559697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 COLLEGE DR",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394060002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 COLLEGE DR",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394060002",
"telephone_number": "601-266-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAUBACH",
"first_name": "TESS",
"middle_name": "MARYANNE",
"name_suffix": "IX",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-21",
"last_updated": "2022-11-29",
"certification_date": "2022-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MS",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHEILD",
"identifier": "TEA806249754",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "tess.maubach@usm.edu",
"affiliation": "N",
"address_1": "118 College Dr # 5017",
"city": "Hattiesburg",
"state": "MS",
"country_code": "US",
"postal_code": "394060002",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.