Individual provider Active NPI

Shiar Thomas Rahaim III, CRNA

  • Anesthesiology Physician
  • Jackson, MS
National Provider Identifier
1548031339
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
901887 Issued in MS
Practice address
1225 N State St
Jackson, MS 39202-2064
Phone
(601) 968-1000
NPI assigned
Jan 11, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 901887 MS Primary

Addresses

Primary practice location

1225 N State St
Jackson, MS 39202-2064

Mailing address

505 Carlyle CT
Madison, MS 39110-7446
Phone (601) 927-1580

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240403001035 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678911161 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Perioperative Services of Mississippi, LLCGroup PAC ID 8921365255, 98 clinicians
Physicians Anesthesia Group, P.a.Group PAC ID 6103806864, 54 clinicians

Practice addresses (Care Compare)

1225 N State St
Ms Baptist Medical Center
Jackson, MS 39202-2064
Phone (601) 317-2802

971 Lakeland Dr
Jackson, MS 39216-4643
Phone (601) 200-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
901887MSMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Perioperative Services of Mississippi, LLC Anesthesiology CurrentSince Feb 5, 2024 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 8, 2024 Accepting new patients
Physicians Anesthesia Group, P.a. Anesthesiology CurrentSince Mar 12, 2024 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 8, 2024 Accepting new patients

Locations

350 Crossgates Blvd
Brandon, MS 39042
Phone (601) 824-8500

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

971 Lakeland Dr
Jackson, MS 39216
Phone (601) 939-5922

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1548031339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 CARLYLE CT",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107446",
            "telephone_number": "601-927-1580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022064",
            "telephone_number": "601-968-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHAIM",
        "first_name": "SHIAR",
        "middle_name": "THOMAS",
        "name_suffix": "III",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "901887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.