Organization Active NPI

The Surgical Clinic Associates, P.a.

  • Surgery Physician
  • Jackson, MS
National Provider Identifier
1821185786
Registry record updated Nov 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
THE SURGICAL CLINIC ASSOCIATES, P.A.
Practice address
501 Marshall St
Suite 500
Jackson, MS 39202-1651
Phone
(601) 948-1411
Fax
(601) 948-0090
NPI assigned
Oct 10, 2006
Last updated
Nov 4, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2009

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

Authorized official

Name
Mr. Terry Hickman, CPA
Title
Administrator
Phone
(601) 948-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MS Primary

Addresses

Primary practice location

501 Marshall St
Suite 500
Jackson, MS 39202-1651

Mailing address

501 Marshall St
Suite 500
Jackson, MS 39202-1651
Phone (601) 948-1411

Other identifiers 1

IdentifierTypeStateIssuer
09012031MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040817001258 MS Part B Supplier - Clinic/Group Practice 4082687058 Receives reassigned benefits from 8 practitioners
Practice locations: Jackson, MS

National Provider Directory

National Provider Directory

Locations

348 Crossgates Blvd
Ste 2400
Brandon, MS 39042
Phone (601) 824-3977

Practitioners & affiliated clinicians

Practitioners 8

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": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257292800000",
    "number": "1821185786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST",
            "address_2": "SUITE 500",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021651",
            "telephone_number": "601-948-1411",
            "fax_number": "601-948-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST",
            "address_2": "SUITE 500",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021651",
            "telephone_number": "601-948-1411",
            "fax_number": "601-948-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SURGICAL CLINIC ASSOCIATES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2009-11-04",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-948-1411",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09012031",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; 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.