NPIMap

Organization Active NPI

Hattiesburg Clinic, P.a.

Doing business as Pachuta Dialysis Unit

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pachuta, MS
National Provider Identifier
1255529228
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
HATTIESBURG CLINIC, P.A.
Doing business as
Pachuta Dialysis Unit
Practice address
180 East Main Street
Pachuta, MS 39347
Phone
(601) 296-2902
Fax
(601) 296-2961
NPI assigned
Oct 4, 2007
Last updated
Jun 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Authorized official

Name
Dr. Bryan N Batson, MD
Title
Exective Director
Phone
(601) 268-5601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

180 East Main Street
Pachuta, MS 39347

Mailing address

5909 Highway 49
Suite 10
Hattiesburg, MS 39402-2860
Phone (601) 296-2902

Other identifiers 1

IdentifierTypeStateIssuer
09856336MedicaidMS

Other names 1

  • Pachuta Dialysis Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071106000608 MS Part A Provider - End-Stage Renal Disease Facility (ESRD) 5193706794 Practice locations: Pachuta, MS

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Pachuta DialysisCCN 252570
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Dec 10, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
9

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1073376Pachuta Dialysis Unit180 East Main Street, Pachuta, MS 39347Certificate of waiverSep 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hattiesburg Clinic PA136 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686700800000",
    "number": "1255529228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 HIGHWAY 49",
            "address_2": "SUITE 10",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394022860",
            "telephone_number": "601-296-2902",
            "fax_number": "601-296-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 EAST MAIN STREET",
            "city": "PACHUTA",
            "state": "MS",
            "postal_code": "39347",
            "telephone_number": "601-296-2902",
            "fax_number": "601-296-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A",
        "authorized_official_last_name": "BATSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-268-5601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09856336",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pachuta Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pachuta, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.