NPIMap

Organization Active NPI

KDMC Physician Clinics LLC

  • Multi-Specialty Clinic/Center
  • Brookhaven, MS
National Provider Identifier
1861739161
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
KDMC PHYSICIAN CLINICS LLC
Practice address
950 Brookway Blvd
Brookhaven, MS 39601-2644
Phone
(601) 823-5103
Fax
(601) 823-3514
NPI assigned
Jan 8, 2013
Last updated
Mar 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
KINGS DAUGHTERS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Authorized official

Name
Mr. Scott Christensen
Title
Ceo
Phone
(601) 835-9488

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

950 Brookway Blvd
Brookhaven, MS 39601-2644

Mailing address

427 Highway 51 N
Brookhaven, MS 39601-2350
Phone (601) 833-6011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130501000541 MS Part B Supplier - Clinic/Group Practice 7012154495 Receives reassigned benefits from 44 practitioners
Practice locations: Brookhaven, MS

National Provider Directory

National Provider Directory
Part of
Kings Daughters Hosp Su

Locations

1014 D a Biglane Dr
Brookhaven, MS 39601
Phone (601) 823-5275

1020 D a Biglane Dr
Brookhaven, MS 39601
Phone (601) 823-8000

439 N Jackson St
Brookhaven, MS 39601
Phone (601) 354-4488

510 Highway 51 N
#C
Brookhaven, MS 39601
Phone (601) 835-9499

1008 H F McCarty Dr
Wesson, MS 39191
Phone (601) 888-7973

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6393/brand/1/csg/41/fhir/r4

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1357603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1861739161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 HIGHWAY 51 N",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012350",
            "telephone_number": "601-833-6011",
            "fax_number": "601-823-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 BROOKWAY BLVD",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012644",
            "telephone_number": "601-823-5103",
            "fax_number": "601-823-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KDMC PHYSICIAN CLINICS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KINGS DAUGHTERS MEDICAL CENTER",
        "enumeration_date": "2013-01-08",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-835-9488",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookhaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.