NPIMap

Organization Active NPI

Susan a Chiarito MD PA Inc

  • Family Medicine Physician
  • Vicksburg, MS
National Provider Identifier
1821152141
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14065 Issued in MS
Legal business name
SUSAN A CHIARITO MD PA INC
Practice address
1901 Mission 66
Vicksburg, MS 39180-3711
Phone
(601) 636-0097
Fax
(601) 629-9969
NPI assigned
Dec 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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

Authorized official

Name
Dr. Susan A Chiarito, M.D.NPI 1871534008
Title
President
Phone
(601) 636-0097

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 14065 MS Primary

Addresses

Primary practice location

1901 Mission 66
Vicksburg, MS 39180-3711

Mailing address

1901 Mission 66
Vicksburg, MS 39180-3711
Phone (601) 636-0097

Other identifiers 1

IdentifierTypeStateIssuer
00112108MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040913000605 MS Part B Supplier - Clinic/Group Practice 0143297804 Receives reassigned benefits from 1 practitioner
Practice locations: Vicksburg, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1821152141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-636-0097",
            "fax_number": "601-629-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-636-0097",
            "fax_number": "601-629-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN A CHIARITO MD PA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "CHIARITO",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-636-0097",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "14065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00112108",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vicksburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; 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.