NPIMap

Organization Active NPI

Delta Endoscopy Center, P.C.

  • Ambulatory Surgical Clinic/Center
  • Southaven, MS
National Provider Identifier
1619923661
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
15684 Issued in MS
Legal business name
DELTA ENDOSCOPY CENTER, P.C.
Practice address
9140 Highway 51 N
Southaven, MS 38671-1233
Phone
(662) 280-8222
Fax
(662) 280-5541
NPI assigned
May 25, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Ulric D. Duncan, M.D.NPI 1518908854
Title
Gastroenterologist
Phone
(662) 280-8222

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
Ambulatory Surgical Clinic/Center 261QA1903X 15684 MS Primary

Addresses

Primary practice location

9140 Highway 51 N
Southaven, MS 38671-1233

Mailing address

9140 Highway 51 N
Southaven, MS 38671-1233
Phone (662) 280-8222

Other identifiers 3

IdentifierTypeStateIssuer
00770356MedicaidMS
4287022OtherMSTENNESEE MEDICAID
3134453OtherMSBLUECROSS BLUESHIELD TN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080304000681 MS Part B Supplier - Ambulatory Surgical Center 3173608916 Receives reassigned benefits from 2 practitioners
Practice locations: Southaven, MS

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Delta Endoscopy Center PCCCN 25C0001021
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1619923661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 HIGHWAY 51 N",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711233",
            "telephone_number": "662-280-8222",
            "fax_number": "662-280-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9140 HIGHWAY 51 N",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711233",
            "telephone_number": "662-280-8222",
            "fax_number": "662-280-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA ENDOSCOPY CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "ULRIC",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "GASTROENTEROLOGIST",
        "authorized_official_telephone_number": "662-280-8222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MS",
            "license": "15684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770356",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNESEE MEDICAID",
            "identifier": "4287022",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD TN",
            "identifier": "3134453",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.