NPIMap

Organization Active NPI

Mississippi State Hospital at Whitfield

  • Psychiatry Physician
  • Whitfield, MS
National Provider Identifier
1497788715
Registry record updated May 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
31-139 Issued in MS
Legal business name
MISSISSIPPI STATE HOSPITAL AT WHITFIELD
Practice address
3550 Hwy 468 West
Whitfield, MS 39193-0157
Phone
(601) 351-8000
Fax
(601) 351-8586
NPI assigned
Jul 9, 2006
Last updated
May 5, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSISSIPPI STATE HOSPITAL AT WHITFIELDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2017

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

Authorized official

Name
Mr. James G Chastain
Title
Director
Phone
(601) 351-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 31-139 MS Primary

Addresses

Primary practice location

3550 Hwy 468 West
Whitfield, MS 39193-0157

Mailing address

PO Box 1 Fiscal Services
3550 Hwy 468 West
Whitfield, MS 39193-0157
Phone (601) 351-8000

Other identifiers 1

IdentifierTypeStateIssuer
09012370MedicaidMS

Other names 1

  • Mississippi State Hospital Physicians Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040330000795 MS Part B Supplier - Clinic/Group Practice 5294727533 Receives reassigned benefits from 64 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Whitfield, MS

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Ms State Hospital Crisis Intervention Center - Clevenlan21 organizations share this tax ID, including this one
Part of
Ms State Hospital Crisis Intervention Center - Clevenlan

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 14

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 14

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": "1493942400000",
    "number": "1497788715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1 FISCAL SERVICES",
            "address_2": "3550 HWY 468 WEST",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000",
            "fax_number": "601-351-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 HWY 468 WEST",
            "city": "WHITFIELD",
            "state": "MS",
            "postal_code": "391930157",
            "telephone_number": "601-351-8000",
            "fax_number": "601-351-8586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI STATE HOSPITAL AT WHITFIELD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSISSIPPI STATE HOSPITAL AT WHITFIELD",
        "enumeration_date": "2006-07-09",
        "last_updated": "2017-05-05",
        "status": "A",
        "authorized_official_last_name": "CHASTAIN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-351-8000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "31-139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09012370",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mississippi State Hospital Physicians",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Whitfield, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.