Individual provider Active NPI

Venkatasubramanian Baskararajan, M.D.

  • Psychiatry Physician
  • Hattiesburg, MS
National Provider Identifier
1407052228
Registry record updated Aug 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20658 Issued in MS
Practice address
1 Lincoln Pkwy
Suite 202
Hattiesburg, MS 39402-3262
Phone
(601) 288-8050
Fax
(601) 288-8058
NPI assigned
Jun 27, 2007
Last updated
Aug 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 658-L MS
Psychiatry Physician 2084P0800X 20658 MS Primary

Addresses

Primary practice location

1 Lincoln Pkwy
Suite 202
Hattiesburg, MS 39402-3262

Mailing address

1 Lincoln Pkwy
Suite 202
Hattiesburg, MS 39402-3262
Phone (601) 288-8050

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
I20090831000674 MS Practitioner - Psychiatry 5496800229 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forrest County General HospitalGroup PAC ID 1052397767, 107 clinicians

Practice addresses (Care Compare)

103 S 19TH Ave
Hattiesburg, MS 39401-6171
Phone (601) 544-4641

2117 Broadway Dr
Hattiesburg, MS 39402-3210
Phone (601) 288-8050

2255 Broadway Dr
Hattiesburg, MS 39402-3254
Phone (601) 288-4800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20658MSMDPsychiatry Physician
658-LMSMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Sep 1, 2009 Accepting new patients
Forrest County General Hospital Psychiatry CurrentSince Sep 1, 2009 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Region 12 Commission on Mental Health & Retardation Pine Belt Men CurrentSince Aug 3, 2015 Accepting new patients

Locations

1 Lincoln Pkwy
Ste 202
Hattiesburg, MS 39402
Phone (601) 288-8050

103 S 19th Ave
Hattiesburg, MS 39401
Phone (601) 544-4222

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

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376611200000",
    "number": "1407052228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY",
            "address_2": "SUITE 202",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023262",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LINCOLN PKWY",
            "address_2": "SUITE 202",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023262",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASKARARAJAN",
        "first_name": "VENKATASUBRAMANIAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-27",
        "last_updated": "2013-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "658-L",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "20658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.