NPIMap

Organization Active NPI

FGH Trauma Surgery Clinic

  • Surgery Physician
  • Hattiesburg, MS
National Provider Identifier
1427090398
Registry record updated Sep 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
FGH TRAUMA SURGERY CLINIC
Practice address
6051 Highway 49
Hattiesburg, MS 39401-7200
Phone
(601) 288-2690
NPI assigned
Jun 12, 2006
Last updated
Sep 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2017

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

Authorized official

Name
Mr. Ben Hester
Title
Cfo
Phone
(601) 288-4225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary

Addresses

Primary practice location

6051 Highway 49
Hattiesburg, MS 39401-7200

Mailing address

PO Box 16745
Hattiesburg, MS 39404-6745
Phone (601) 288-2690

Other identifiers 1

IdentifierTypeStateIssuer
05102728MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050119000801 MS Part B Supplier - Clinic/Group Practice 7517916331 Receives reassigned benefits from 27 practitioners
Practice locations: Hattiesburg, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505174400000",
    "number": "1427090398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16745",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394046745",
            "telephone_number": "601-288-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6051 HIGHWAY 49",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017200",
            "telephone_number": "601-288-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FGH TRAUMA SURGERY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2017-09-12",
        "status": "A",
        "authorized_official_last_name": "HESTER",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "601-288-4225",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05102728",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 12, 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.