NPIMap

Organization Active NPI

Hattiesburg Clinic, PA

Doing business as Tylertown Dialysis Unit

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Tylertown, MS
National Provider Identifier
1821021155
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
Tylertown Dialysis Unit
Practice address
4820 Plaza Dr
Tylertown, MS 39667-9221
Phone
(601) 222-0311
Fax
(601) 222-0351
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
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

4820 Plaza Dr
Tylertown, MS 39667-9221

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 222-0311

Other identifiers 3

IdentifierTypeStateIssuer
000050656OtherMSBLUE CROSS BLUE SHIELD MS
5000477OtherMSUNITED HEALTHCARE
00220570MedicaidMS

Other names 1

  • Tylertown 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
O20111227000778 MS Part A Provider - End-Stage Renal Disease Facility (ESRD) 5193706794 Practice locations: Tylertown, MS

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Tylertown DialysisCCN 252559
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jan 10, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
20

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

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

Locations

4820 Plaza Dr
Tylertown, MS 39667
Phone (601) 222-0311

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

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": "1821021155",
    "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": "601-222-0311",
            "fax_number": "601-222-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4820 PLAZA DR",
            "city": "TYLERTOWN",
            "state": "MS",
            "postal_code": "396679221",
            "telephone_number": "601-222-0311",
            "fax_number": "601-222-0351"
        }
    ],
    "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."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MS",
            "identifier": "000050656",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "5000477",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220570",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tylertown Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tylertown Dialysis Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tylertown, 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.
  • 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.