NPIMap

Organization Active NPI

Hattiesburg Clinic, PA

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Picayune, MS
National Provider Identifier
1477586782
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
HATTIESBURG CLINIC, PA
Practice address
1835 Cooper Rd
Picayune, MS 39466-2838
Phone
(601) 798-8951
Fax
(601) 798-6939
NPI assigned
Jul 9, 2006
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, MD
Title
Executive Director
Phone
(601) 264-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1835 Cooper Rd
Picayune, MS 39466-2838

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 798-8951

Other identifiers 3

IdentifierTypeStateIssuer
5000477OtherMSUNITED HEALTHCARE
000050280OtherMSBLUE CROSS BLUE SHIELD MS
00020345MedicaidMS

Other names 1

  • Pearl River Dialysis Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111123000106 MS Part A Provider - End-Stage Renal Disease Facility (ESRD) 5193706794 Practice locations: Picayune, MS

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Pearl River DialysisCCN 252517
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Feb 9, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
20

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0318923Pearl River Dialysis Unit1835 Cooper Road, Picayune, MS 39466Certificate of waiverAug 31, 2026

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1477586782",
    "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": "601-798-8951",
            "fax_number": "601-798-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 COOPER RD",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394662838",
            "telephone_number": "601-798-8951",
            "fax_number": "601-798-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "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",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "5000477",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MS",
            "identifier": "000050280",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020345",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearl River Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pearl River Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Picayune, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.