Evan Reed Sobiesk

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4160-20 Issued in MS

Practice address

1421 S 28TH Ave
Hattiesburg, MS 39402-3108

Phone

(601) 264-7611

NPI assigned

Apr 26, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Group practices

Oral and Maxillofacial Surgery Clinic of South Misssissippi, P.a.Group PAC ID 2163501602, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral & Maxillofacial Surgery Clinic of South Misssissippi, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Hattiesburg, MS
  • NPI 1578596060
  Medicare reassignment Care Compare group NPD
• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment NPD
• South Mississippi Oral Surgery & Implant Center PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Gulfport, MS
  • NPI 1780466300
  NPD
• State of Mississippi - University of Mississippi Medical Center

  • Prosthetic/Orthotic Supplier
  • Jackson, MS
  • NPI 1235019530
  NPD

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

{
    "created_epoch": "1587859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1801416219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023108",
            "telephone_number": "601-264-7611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023108",
            "telephone_number": "601-264-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOBIESK",
        "first_name": "EVAN",
        "middle_name": "REED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-26",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MS",
            "license": "4160-20",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "4160-20",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Smith, LCSW
• Stephanie Lee Smith, ATC/L
• Terri T Smith
• Zoee Smith
• Cecilia Snyder, RD
• John D Sobiesk, MD
• John Logan Sobiesk, MD
• Sarah Grace Whitehead Sobiesk
• Solace Health, PLLC
• Solid Ground Recovery LLC

• Oral and Maxillofacial Surgery (Dentist) in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.