NPIMap

Organization Active NPI

Hattiesburg Clinic, P.a

Doing business as Silver Creek DialysisUnit

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Silver Creek, MS
National Provider Identifier
1982649620
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
HATTIESBURG CLINIC, P.A
Doing business as
Silver Creek DialysisUnit
Practice address
21 Emu Lane
Silver Creek, MS 39663
Phone
(601) 886-0072
Fax
(601) 886-0106
NPI assigned
Jun 17, 2006
Last updated
Feb 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Authorized official

Name
Dr. Bryan N Batson
Title
Executive Director
Phone
(601) 264-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

21 Emu Lane
Silver Creek, MS 39663

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 886-0072

Other names 1

  • Silver Creek DialysisUnit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050622001435 MS Part A Provider - End-Stage Renal Disease Facility (ESRD) 5193706794 Practice locations: Silver Creek, MS

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Silver Creek DialysisCCN 252569
Overall star rating
4.0 of 5
Ownership
Profit
Certified
May 31, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
18

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Hattiesburg Clinic PA136 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1982649620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-886-0072",
            "fax_number": "601-886-0106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 EMU LANE",
            "city": "SILVER CREEK",
            "state": "MS",
            "postal_code": "39663",
            "telephone_number": "601-886-0072",
            "fax_number": "601-886-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG CLINIC, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "BATSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-264-6000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silver Creek DialysisUnit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Silver Creek DialysisUnit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Silver Creek, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.