NPIMap

Organization Active NPI

Forrest County General Hospital

Doing business as Highland Internal Medicine Clinic

  • Internal Medicine Physician
  • Carriere, MS
National Provider Identifier
1619008174
Registry record updated Dec 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
FORREST COUNTY GENERAL HOSPITAL
Doing business as
Highland Internal Medicine Clinic
Practice address
200 Country Club Rd
Carriere, MS 39426
Phone
(601) 799-4777
Fax
(601) 799-0052
NPI assigned
Mar 8, 2007
Last updated
Dec 7, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2017

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

Authorized official

Name
David Pylate
Title
Patient Accounts Manager
Phone
(601) 288-1864

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

200 Country Club Rd
Carriere, MS 39426

Mailing address

PO Box 15722
Hattiesburg, MS 39404-5722
Phone (601) 288-1823

Other identifiers 4

IdentifierTypeStateIssuer
110001530OtherMSMEDICARE INDIVIDUAL
1658723MedicaidLA
P007466664OtherMEDICARE RAILROAD
09520729MedicaidMS

Other names 1

  • Highland Internal Medicine Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040624001351 MS Part B Supplier - Clinic/Group Practice 1052397767 Receives reassigned benefits from 246 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Prentiss, MS; Poplarville, MS; Hattiesburg, MS; Picayune, MS; Laurel, MS; Columbia, MS

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512604800000",
    "number": "1619008174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15722",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394045722",
            "telephone_number": "601-288-1823",
            "fax_number": "601-288-1877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COUNTRY CLUB RD",
            "city": "CARRIERE",
            "state": "MS",
            "postal_code": "39426",
            "telephone_number": "601-799-4777",
            "fax_number": "601-799-0052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORREST COUNTY GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2017-12-07",
        "status": "A",
        "authorized_official_last_name": "PYLATE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "601-288-1864"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL",
            "identifier": "110001530",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1658723",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P007466664",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09520729",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Highland Internal Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Highland Internal Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carriere, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.