Individual provider Active NPI

Scott S Paladichuk, O.D.

  • Optometrist
  • Hattiesburg, MS
National Provider Identifier
1962649657
Registry record updated Jan 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
829 Issued in MS
Practice address
100 Hospital Dr W
Hattiesburg, MS 39402-1334
Phone
(601) 268-5910
Fax
(601) 264-0659
NPI assigned
Jan 16, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Optometrist 152W00000X 2895 TN
Optometrist 152W00000X 829 MS Primary

Addresses

Primary practice location

100 Hospital Dr W
Hattiesburg, MS 39402-1334

Mailing address

100 Hospital Dr W
Hattiesburg, MS 39402-1334
Phone (601) 268-5910

Other identifiers 4

IdentifierTypeStateIssuer
1160823OtherMSCIGNA
9036592OtherMSAETNA
00154827MedicaidMS
6041813OtherMSHEALTHSPRING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101112001005 MS Practitioner - Optometry 5496899650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hattiesburg Eye Clinic, P.a.Group PAC ID 4587733829, 12 clinicians

Practice addresses (Care Compare)

100 Hospital Dr W
Hattiesburg, MS 39402-1334
Phone (601) 268-5910

Merit-based Incentive Payment System (MIPS)

Final score
81.78 of 100Reported as group
Quality
89.54
Improvement activities
40
Cost
53.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2895TNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Eye Clinic, P.a. Optometrist CurrentSince Jan 5, 2015 Accepting new patients
Hattiesburg Eye Clinic, P.a. Optometrist CurrentSince Jan 5, 2015 Accepting new patients
Childrens Hospital of Wisconsin, Inc. Past Accepting new patients

Locations

1001 Highway 98 Byp
Columbia, MS 39429
Phone (601) 620-0470

426 Broad St
Columbia, MS 39429

100 Hospital Dr W
Hattiesburg, MS 39402
Phone (601) 268-5910

1711 W 20th St
Laurel, MS 39440
Phone (650) 660-1649

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420416000000",
    "number": "1962649657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR W",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021334",
            "telephone_number": "601-268-5910",
            "fax_number": "601-264-0659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR W",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021334",
            "telephone_number": "601-268-5910",
            "fax_number": "601-264-0659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALADICHUK",
        "first_name": "SCOTT",
        "middle_name": "S",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-16",
        "last_updated": "2015-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2895",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1160823",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9036592",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00154827",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSPRING",
            "identifier": "6041813",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.