NPIMap

Organization Active NPI

SMB Radiology P a

  • Diagnostic Radiology Physician
  • Pascagoula, MS
National Provider Identifier
1609877356
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SMB RADIOLOGY P A
Practice address
1365 Market St
Pascagoula, MS 39567-6604
Phone
(228) 762-1353
Fax
(228) 762-1359
NPI assigned
Aug 3, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Dr. Clifton T Leatherbury, MDNPI 1548460629
Title
President
Phone
(228) 762-1353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

1365 Market St
Pascagoula, MS 39567-6604

Mailing address

PO Box 749627
Atlanta, GA 30374-9627
Phone (866) 264-3435

Other identifiers 1

IdentifierTypeStateIssuer
09014149MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AL, FL, TN, CA, NY, LA, KY8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
O20061108000496 MS Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 23 practitioners
Practice locations: Pascagoula, MS; Biloxi, MS; Ocean Springs, MS; Hurley, MS; Gulfport, MS; Diberville, MS
O20221020000222 AL Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 4 practitioners
Practice locations: Birmingham, AL
O20221220000297 FL Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 5 practitioners
Practice locations: Tarpon Springs, FL; Tampa, FL; Orlando, FL; Melbourne, FL; New Port Richey, FL
O20241202003266 TN Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 2 practitioners
Practice locations: Brentwood, TN; Franklin, TN
O20250117002366 CA Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 1 practitioner
Practice locations: Santa Monica, CA
O20250224000290 NY Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 2 practitioners
Practice locations: Mount Vernon, NY; New Hartford, NY
O20250226004021 LA Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 1 practitioner
Practice locations: New Orleans, LA
O20250902001493 KY Part B Supplier - Clinic/Group Practice 9234136060 Receives reassigned benefits from 1 practitioner
Practice locations: Somerset, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1609877356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749627",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749627",
            "telephone_number": "866-264-3435",
            "fax_number": "706-596-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 MARKET ST",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395676604",
            "telephone_number": "228-762-1353",
            "fax_number": "228-762-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMB RADIOLOGY P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "LEATHERBURY",
        "authorized_official_first_name": "CLIFTON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-762-1353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09014149",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.