NPIMap

Organization Active NPI

Southern Bone & Joint Specialists, PA

  • Orthopaedic Surgery Physician
  • Columbia, MS
National Provider Identifier
1487901807
Registry record updated Aug 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SOUTHERN BONE & JOINT SPECIALISTS, PA
Practice address
1215 Highway 98 Byp
Columbia, MS 39429-3702
Phone
(601) 554-7400
Fax
(601) 554-7488
NPI assigned
Aug 6, 2012
Organization subpart
Yes
Parent organization
SOUTHERN BONE & JOINT SPECIALISTS, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2012

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

Authorized official

Name
Mr. David M Burckel
Title
Ceo
Phone
(601) 554-7449

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

1215 Highway 98 Byp
Columbia, MS 39429-3702

Mailing address

3688 Veterans Memorial Dr
Suite 200
Hattiesburg, MS 39401-8246
Phone (601) 554-7400

Other identifiers 1

IdentifierTypeStateIssuer
09015183MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121113000409 MS DME Supplier - Physician - Orthopedic/Orthopedic Surgery 1254328818 Practice locations: Columbia, MS

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Southern Bone Joint Specia7 organizations share this tax ID, including this one
Part of
Southern Bone Joint Specia

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1344211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344211200000",
    "number": "1487901807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3688 VETERANS MEMORIAL DR",
            "address_2": "SUITE 200",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018246",
            "telephone_number": "601-554-7400",
            "fax_number": "601-554-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 HIGHWAY 98 BYP",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293702",
            "telephone_number": "601-554-7400",
            "fax_number": "601-554-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BONE & JOINT SPECIALISTS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN BONE & JOINT SPECIALISTS, PA",
        "enumeration_date": "2012-08-06",
        "last_updated": "2012-08-06",
        "status": "A",
        "authorized_official_last_name": "BURCKEL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-554-7449",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015183",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; 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.