NPIMap

Organization Active NPI

Serenity Psychiatric Outpatient, LLC

  • Clinical Social Worker
  • McComb, MS
National Provider Identifier
1881973642
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SERENITY PSYCHIATRIC OUTPATIENT, LLC
Practice address
300 Rawls Dr Ste 900
McComb, MS 39648-2864
Phone
(601) 684-8284
Fax
(601) 684-8199
NPI assigned
Aug 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Authorized official

Name
Kristi Stogner, LCSWNPI 1922266311
Title
President
Phone
(601) 684-8284

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
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

300 Rawls Dr Ste 900
McComb, MS 39648-2864

Mailing address

300 Rawls Dr Ste 900
McComb, MS 39648-2864
Phone (601) 684-8284

Other identifiers 1

IdentifierTypeStateIssuer
05503121MedicaidMS

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL kstogner@serenitypsych.ms Direct
CONNECT URL mrobinson@serenitypsych.ms Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110914000274 MS Part B Supplier - Clinic/Group Practice 7911181805 Receives reassigned benefits from 7 practitioners
Practice locations: McComb, MS; Tylertown, MS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Colonial Haven Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11 Pecan Dr
Columbia, MS 39429
Phone (601) 731-5717

1312 Harrison Ave
Ste C
McComb, MS 39648
Phone (601) 684-8284

Practitioners & affiliated clinicians

Practitioners 7

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": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1881973642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RAWLS DR STE 900",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482864",
            "telephone_number": "601-684-8284",
            "fax_number": "601-684-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RAWLS DR STE 900",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482864",
            "telephone_number": "601-684-8284",
            "fax_number": "601-684-8199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY PSYCHIATRIC OUTPATIENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "STOGNER",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-684-8284",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05503121",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kstogner@serenitypsych.ms",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 Rawls Dr Ste 900",
            "city": "McComb",
            "state": "MS",
            "country_code": "US",
            "postal_code": "396482864",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mrobinson@serenitypsych.ms",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 Rawls Dr Ste 900",
            "city": "McComb",
            "state": "MS",
            "country_code": "US",
            "postal_code": "396482864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in McComb, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.