NPIMap

Organization Active NPI

Hattiesburg Clinic, PA

Doing business as Hattiesburg Dialysis Unit

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hattiesburg, MS
National Provider Identifier
1720011026
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
HATTIESBURG CLINIC, PA
Doing business as
Hattiesburg Dialysis Unit
Practice address
5909 U S Highway 49 Ste 10
Hattiesburg, MS 39402-2860
Phone
(601) 296-2960
Fax
(601) 296-2961
NPI assigned
Jul 9, 2006
Last updated
Feb 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Authorized official

Name
Dr. Bryan N Batson, MD
Title
Executive Director
Phone
(601) 264-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

5909 U S Highway 49 Ste 10
Hattiesburg, MS 39402-2860

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 296-2960

Other identifiers 3

IdentifierTypeStateIssuer
00020337MedicaidMS
000050260OtherMSBLUE CROSS BLUE SHIELD MS
5000477OtherMSUNITED HEALTHCARE

Other names 1

  • Hattiesburg Dialysis Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111227000800 MS Part A Provider - End-Stage Renal Disease Facility (ESRD) 5193706794 Practice locations: Hattiesburg, MS

National Provider Directory

National Provider Directory
Tax ID family
Hattiesburg Clinic PA136 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1720011026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-296-2960",
            "fax_number": "601-296-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5909 U S HIGHWAY 49 STE 10",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394022860",
            "telephone_number": "601-296-2960",
            "fax_number": "601-296-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "BATSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-264-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020337",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MS",
            "identifier": "000050260",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "5000477",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hattiesburg Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hattiesburg Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 22, 2021; 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.