NPIMap

Organization Active NPI

Southern Ms Heart Center,PA

  • Cardiovascular Disease Physician
  • Ocean Springs, MS
National Provider Identifier
1306062641
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
SOUTHERN MS HEART CENTER,PA
Practice address
3704 Bienville Blvd Ste B
Ocean Springs, MS 39564-5710
Phone
(228) 872-4040
Fax
(228) 872-3612
NPI assigned
Apr 17, 2007
Last updated
Feb 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Authorized official

Name
Mrs. Rhonda Boney
Title
Office Manager
Phone
(228) 872-4040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

3704 Bienville Blvd Ste B
Ocean Springs, MS 39564-5710

Mailing address

3704 Bienville Blvd Ste B
Ocean Springs, MS 39564-5710
Phone (228) 872-4040

Other identifiers 1

IdentifierTypeStateIssuer
09014546MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040401000678 MS Part B Supplier - Clinic/Group Practice 9739171463 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
Practice locations: Gulfport, MS; Pascagoula, MS; Ocean Springs, MS

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

4300 Hospital St
Ste 102
Pascagoula, MS 39581
Phone (228) 372-8270

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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1306062641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3704 BIENVILLE BLVD STE B",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645710",
            "telephone_number": "228-872-4040",
            "fax_number": "228-872-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3704 BIENVILLE BLVD STE B",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645710",
            "telephone_number": "228-872-4040",
            "fax_number": "228-872-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MS HEART CENTER,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "BONEY",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "228-872-4040",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014546",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean Springs, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.