Active NPI
Kevin Mark Passer, M.D.
- Psychiatry Physician
- Hattiesburg, MS
National Provider Identifier
1558379263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 13970
- Practice address
- 5317-4 Old Highway 11
Hattiesburg, MS 39402 - Phone
- (601) 261-9101
- Fax
- (601) 261-9102
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 13970 | MS | Primary |
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | 13970 | MS |
Addresses
Primary practice location
5317-4 Old Highway 11
Hattiesburg, MS 39402
Mailing address
6068 Highway 98 West
Suite 1-255
Hattiesburg, MS 39402
Phone (601) 261-9101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2016 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13970 | MS | MD | Addiction Medicine (Psychiatry & Neurology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1558379263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6068 HIGHWAY 98 WEST",
"address_2": "SUITE 1-255",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "39402",
"telephone_number": "601-261-9101",
"fax_number": "601-261-9102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5317-4 OLD HIGHWAY 11",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "39402",
"telephone_number": "601-261-9101",
"fax_number": "601-261-9102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSER",
"first_name": "KEVIN",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MS",
"license": "13970",
"primary": true
},
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "MS",
"license": "13970",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.