NPIMap

Organization Active NPI

Southern Eye Surgery and Laser Center, LLC

  • Anesthesiology Physician
  • Laurel, MS
National Provider Identifier
1295244226
Registry record updated Sep 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SOUTHERN EYE SURGERY AND LASER CENTER, LLC
Practice address
1923 W 10TH St
Laurel, MS 39440-2538
Phone
(601) 264-3937
Fax
(601) 264-3937
NPI assigned
Sep 21, 2017
Last updated
Sep 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2017

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

Authorized official

Name
Kiper C Nelson, MDNPI 1548263312
Title
Owner, LLC Member
Phone
(601) 264-3937

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

1923 W 10TH St
Laurel, MS 39440-2538

Mailing address

1420 S 28TH Ave
Hattiesburg, MS 39402-3107
Phone (601) 264-3937

Other names 1

  • Anesthesia Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171114002076 MS Part B Supplier - Clinic/Group Practice 5496030595 Receives reassigned benefits from 14 practitioners
Practice locations: Laurel, MS

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Anesthesia2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505952000000",
    "number": "1295244226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023107",
            "telephone_number": "601-264-3937",
            "fax_number": "601-264-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 W 10TH ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402538",
            "telephone_number": "601-264-3937",
            "fax_number": "601-264-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN EYE SURGERY AND LASER CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-21",
        "last_updated": "2017-09-21",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KIPER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER, LLC MEMBER",
        "authorized_official_telephone_number": "601-264-3937",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anesthesia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; 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.