NPIMap

Organization Active NPI

Vascular Access Center of Bolivar County LLC

  • Vascular & Interventional Radiology Physician
  • Cleveland, MS
National Provider Identifier
1851620249
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
VASCULAR ACCESS CENTER OF BOLIVAR COUNTY LLC
Practice address
810 E Sunflower Rd
Suite 100B
Cleveland, MS 38732-2800
Phone
(662) 579-3484
Fax
(662) 579-3485
NPI assigned
Dec 14, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Mrs. Rae Crews
Title
Director of Operations
Phone
(662) 579-3484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

810 E Sunflower Rd
Suite 100B
Cleveland, MS 38732-2800

Mailing address

285 Wilmington W Chester Pike
Chadds Ford, PA 19317-9039
Phone (610) 558-2800

Other names 1

  • Endovascular Health Services of Bolivar County Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100611000303 MS Part B Supplier - Clinic/Group Practice 9931239365 Receives reassigned benefits from 8 practitioners
Practice locations: Cleveland, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2007119Vascular Access Center of Bolivar County LLC810 E Sunflower Road Suite 100B, Cleveland, MS 38732Certificate of waiverMay 6, 2028

National Provider Directory

National Provider Directory

Locations

810 E Sunflower Rd
Ste 100B
Cleveland, MS 38732
Phone (662) 579-3484

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1260748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1851620249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 WILMINGTON W CHESTER PIKE",
            "city": "CHADDS FORD",
            "state": "PA",
            "postal_code": "193179039",
            "telephone_number": "610-558-2800",
            "fax_number": "610-558-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 E SUNFLOWER RD",
            "address_2": "SUITE 100B",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322800",
            "telephone_number": "662-579-3484",
            "fax_number": "662-579-3485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR ACCESS CENTER OF BOLIVAR COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-14",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "CREWS",
        "authorized_official_first_name": "RAE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "662-579-3484",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endovascular Health Services of Bolivar County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.