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Organization Active NPI

Orthopedic Clinic of Southwest Mississippi

  • Sports Medicine (Orthopaedic Surgery) Physician
  • McComb, MS
National Provider Identifier
1972694172
Registry record updated Aug 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
ORTHOPEDIC CLINIC OF SOUTHWEST MISSISSIPPI
Practice address
300 Rawls Dr
Suite 400
McComb, MS 39648-2877
Phone
(601) 684-4613
Fax
(601) 249-2226
NPI assigned
Sep 27, 2006
Last updated
Aug 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2007

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

Authorized official

Name
Mrs. David Sinclair
Title
Director
Phone
(601) 249-2701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X Primary

Addresses

Primary practice location

300 Rawls Dr
Suite 400
McComb, MS 39648-2877

Mailing address

300 Rawls Dr
Suite 400
McComb, MS 39648-2877
Phone (601) 684-4613

Other identifiers 1

IdentifierTypeStateIssuer
07985398MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080512000004 MS Part B Supplier - Clinic/Group Practice 5193633907 Receives reassigned benefits from 86 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McComb, MS; Summit, MS; Monticello, MS

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1972694172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 RAWLS DR",
            "address_2": "SUITE 400",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482877",
            "telephone_number": "601-684-4613",
            "fax_number": "601-249-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 RAWLS DR",
            "address_2": "SUITE 400",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396482877",
            "telephone_number": "601-684-4613",
            "fax_number": "601-249-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC CLINIC OF SOUTHWEST MISSISSIPPI",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "SINCLAIR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-249-2701",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07985398",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "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 Aug 28, 2007; 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.