Breck T Richardson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

21932 Issued in MS

Practice address

332 Hwy 12 West
Kosciusko, MS 39090

Phone

(662) 289-1800

Fax

(662) 289-2486

NPI assigned

Apr 8, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Medical Group of Mississippi LLC

  • Clinic/Center
  • Kosciusko, MS
  • NPI 1790827038
  NPD
• Premier Medical Group of Mississippi LLC

  • Clinic/Center
  • Jackson, MS
  • NPI 1548219884
  NPD (past)
• Rankin Children'S Group, PLLC

  • Pediatrics Physician
  • Brandon, MS
  • NPI 1417171794
  NPD (past)

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355184000000",
    "number": "1962645770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23996",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39225",
            "telephone_number": "601-206-6100",
            "fax_number": "601-206-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 HWY 12 WEST",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "39090",
            "telephone_number": "662-289-1800",
            "fax_number": "662-289-2486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "BRECK",
        "middle_name": "T",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-08",
        "last_updated": "2012-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "21932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09723710",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Margaret Rawson, LPC, NCC
• George Robert Rea, RPH
• Joy W Reynolds, NP-C
• Elizabeth Louise Rhea
• Brady L Richardson, MD
• Allison Roach
• Robin Pee Counseling & Consulting LLC
• Ronnie S. Christian, MD, P. C.
• Routt Eye Clinic
• Lawrence Adrian Routt Sr., O.D.

• Pediatrics Physician in Kosciusko, MS
• Providers in Kosciusko, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.