Organization Active NPI

Central Mississippi Foot Specialist, PLLC

  • Foot Surgery Podiatrist
  • Brandon, MS
National Provider Identifier
1407052319
Registry record updated Apr 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
80160 Issued in MS
Legal business name
CENTRAL MISSISSIPPI FOOT SPECIALIST, PLLC
Practice address
103 Service Dr
Brandon, MS 39042-2401
Phone
(601) 824-4700
Fax
(601) 824-4800
NPI assigned
Jun 26, 2007
Last updated
Apr 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2015

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

Authorized official

Name
Lawrence Edward Tamburino, D.P.M,NPI 1083689277
Title
Doctor of Podiatric Medicine
Phone
(601) 824-4700

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
Foot Surgery Podiatrist 213ES0131X 80160 MS Primary

Addresses

Primary practice location

103 Service Dr
Brandon, MS 39042-2401

Mailing address

103 Service Dr
Brandon, MS 39042-2401
Phone (601) 824-4700

Other identifiers 1

IdentifierTypeStateIssuer
09015930MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080424000555 MS Part B Supplier - Clinic/Group Practice 9537247960 Receives reassigned benefits from 1 practitioner
Practice locations: Brandon, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430092800000",
    "number": "1407052319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SERVICE DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422401",
            "telephone_number": "601-824-4700",
            "fax_number": "601-824-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SERVICE DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422401",
            "telephone_number": "601-824-4700",
            "fax_number": "601-824-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MISSISSIPPI FOOT SPECIALIST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2015-04-27",
        "status": "A",
        "authorized_official_last_name": "TAMBURINO",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DOCTOR OF PODIATRIC MEDICINE",
        "authorized_official_telephone_number": "601-824-4700",
        "authorized_official_credential": "D.P.M,"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "MS",
            "license": "80160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015930",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; 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.