NPIMap

Organization Active NPI

Hattiesburg Clinic PA

Doing business as Bellevue Physical Therapy

  • Physical Therapist
  • Hattiesburg, MS
National Provider Identifier
1407938814
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
HATTIESBURG CLINIC PA
Doing business as
Bellevue Physical Therapy
Practice address
7148 US Highway 98
Suite 102
Hattiesburg, MS 39402
Phone
(601) 261-1550
Fax
(601) 268-2530
NPI assigned
Oct 19, 2006
Last updated
Feb 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

Name
Bryan N Batson
Title
Executive Director
Phone
(601) 264-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

7148 US Highway 98
Suite 102
Hattiesburg, MS 39402

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463

Other identifiers 1

IdentifierTypeStateIssuer
01629784MedicaidMS

Other names 1

  • Bellevue Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140904001038 MS DME Supplier - Independently-Practicing Physical Therapist 5193706794 Practice locations: Hattiesburg, MS

National Provider Directory

National Provider Directory
Tax ID family
Hattiesburg Clinic PA136 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

7148 U S Highway 98
Hattiesburg, MS 39402
Phone (601) 261-1500

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1407938814",
    "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": "601-579-5463",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7148 US HIGHWAY 98",
            "address_2": "SUITE 102",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39402",
            "telephone_number": "601-261-1550",
            "fax_number": "601-268-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "BATSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-264-6000"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01629784",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bellevue Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bellevue Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.