NPIMap

Organization Active NPI

South Central Regional Medical Center

Doing business as South Central Dermatology

  • Dermatology Physician
  • Laurel, MS
National Provider Identifier
1467183418
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Doing business as
South Central Dermatology
Practice address
1410 Jefferson St
Laurel, MS 39440-4243
Phone
(601) 425-4860
NPI assigned
Jun 21, 2022
Last updated
Oct 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Brittany Hasbargen
Title
Director
Phone
(601) 426-4795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

1410 Jefferson St
Laurel, MS 39440-4243

Mailing address

PO Box 607
Laurel, MS 39441-0607
Phone (601) 426-4795

Other practice location 1

701 S Holly Ave
Collins, MS 39428-3894
Phone (601) 425-4860

Other names 1

  • South Central Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000259 MS Part B Supplier - Clinic/Group Practice 8325946411 Receives reassigned benefits from 17 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurel, MS

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1467183418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394410607",
            "telephone_number": "601-426-4795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404243",
            "telephone_number": "601-425-4860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 S Holly Ave",
            "address_purpose": "LOCATION",
            "city": "Collins",
            "state": "MS",
            "postal_code": "394283894",
            "country_code": "US",
            "telephone_number": "601-425-4860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH CENTRAL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-21",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "HASBARGEN",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-426-4795"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Central Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Central Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.