NPIMap

Individual provider Active NPI

Rambod Rouhbakhsh, MD

  • Family Medicine Physician
  • Hattiesburg, MS
National Provider Identifier
1285680264
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
18638 Issued in MS
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 579-3300
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD28720 OR
Family Medicine Physician 207Q00000X 18638 MS Primary

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-3300

Other identifiers 2

IdentifierTypeStateIssuer
02801001MedicaidMS
026076MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rrouhbakhsh52830@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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041001000134 MS Practitioner - Family Practice 7214906643 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oregon Health Sciences University School of Medicine, 2001
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)

415 S 28TH Ave
FL 1
Hattiesburg, MS 39401-7246
Phone (601) 579-3300

Hospital & facility affiliations

  • Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18638MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital Current Accepting new patients
Forrest General Hospital CurrentSince Sep 1, 2018 Accepting new patients
Forrest County General Hospital CurrentSince Sep 1, 2018 Accepting new patients
Hattiesburg Clinic, PA CurrentSince Jul 13, 2016 Accepting new patients
Hattiesburg Clinic PA CurrentSince Jul 13, 2016 Accepting new patients
Forrest County General Hospital Past Accepting new patients
Legacy Meridian Park Hospital Past Accepting new patients
Dallas Oregon Emergency Physicians LLC PastSince Oct 1, 2023 Accepting new patients

Locations

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

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

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

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

Interoperability endpoints

  • Direct secure messaging: rrouhbakhsh52830@directpatientrecord.com

Organizations & group practices 30

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.

View all 30

Hospital & facility affiliations 1

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1285680264",
    "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": "601-579-3300",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-579-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUHBAKHSH",
        "first_name": "RAMBOD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD28720",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "18638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02801001",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026076",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rrouhbakhsh52830@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "415 S 28th Ave",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394017246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.