Digestive Diseases Center of Hattiesburg, LLC

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

Legal business name

DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC

Practice address

1000 Turtle Creek Dr Ste 4
Hattiesburg, MS 39402-1173

Phone

(601) 268-5189

Fax

(601) 268-5006

NPI assigned

Aug 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Stephen E Buckley, M.D.NPI 1740283126

Title

Medical Director

Phone

(601) 268-5189

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Listed as

Digestive Diseases Center of Hattiesburg LLCCCN 25C0001053

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 3

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

• Stephen E Buckley, M.D.

  • Gastroenterology Physician
  • Hattiesburg, MS
  • NPI 1740283126
  NPD Authorized official
• Erin Kathleen Roberts, NP-C

  • Family Nurse Practitioner
  • Hattiesburg, MS
  • NPI 1942761382
  NPD (past)
• Cynthia C Townsend, ARNP, FNP-BC

  • Nurse Practitioner
  • Santa Rosa Beach, FL
  • NPI 1639172018
  NPD (past)

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674432000000",
    "number": "1598879009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 METHODIST HOSPITAL BLVD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021295",
            "telephone_number": "601-268-5189",
            "fax_number": "601-268-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TURTLE CREEK DR STE 4",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021173",
            "telephone_number": "601-268-5189",
            "fax_number": "601-268-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE DISEASES CENTER OF HATTIESBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A",
        "authorized_official_last_name": "BUCKLEY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "601-268-5189",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02358833",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00138452",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chandra Rae Dewberry
• Chad J Diamond, DO
• Mary Noel Dickerson, FNP
• Andrew L Dickson, PHD
• Anna Katelyn Dickson, DO
• Michael Digulimio, CMHT
• Adrian Dill
• Tabitha Ashley Dillard
• Megan Dillon, MD
• Dixie Attendance Center

• All providers in Hattiesburg, MS
• Endoscopy Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; 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.