Individual provider Active NPI

Victoria Scott Sivils, M.D.

  • Pediatrics Physician
  • Hattiesburg, MS
National Provider Identifier
1265896229
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
28736 Issued in MS
Practice address
101 Medical Park
Hattiesburg, MS 39401-9042
Phone
(601) 579-3000
Fax
(601) 579-5240
NPI assigned
Apr 6, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 36305 AL
Pediatrics Physician 208000000X 28736 MS Primary

Addresses

Primary practice location

101 Medical Park
Hattiesburg, MS 39401-9042

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-3000

Other identifiers 1

IdentifierTypeStateIssuer
03986091MedicaidMS

Other names 1

  • Victoria Scott Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vsivils113473@directpatientrecord.com Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210712002792 MS Practitioner - Pediatric Medicine 1759678667 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36305ALMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic, PA CurrentSince Jul 1, 2021 Accepting new patients
Hattiesburg Clinic PA CurrentSince Jul 1, 2021 Accepting new patients
Hattiesburg Clinic, PA Past Accepting new patients
Forrest County General Hospital Past Accepting new patients
University of Alabama Health Services Foundation, PC. Past Accepting new patients

Locations

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

101 Medical Park
Hattiesburg, MS 39401
Phone (601) 268-3735

Interoperability endpoints

  • Direct secure messaging: vsivils113473@directpatientrecord.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1265896229",
    "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": "601-579-3000",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MEDICAL PARK",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394019042",
            "telephone_number": "601-579-3000",
            "fax_number": "601-579-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVILS",
        "first_name": "VICTORIA",
        "middle_name": "SCOTT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-06",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "36305",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "28736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03986091",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vsivils113473@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "101 Medical Park",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394019042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "SCOTT",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.