HATTIESBURG CLINIC PA
NPI 1154410017
Clinic/Center - Adolescent and Children Mental Health in Hattiesburg, MS
NPI Status: Active since October 11, 2006
Contact Information
102 MEDICAL PARK
HATTIESBURG, MS
ZIP 39401
Phone: (601) 261-5159
Fax: (601) 545-1740
- Organization
- Clinic/Center
- Adolescent and Children Mental Health
- Accepts Insurance
- CLIA Number: 25D2155784
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 10-03-2026
About HATTIESBURG CLINIC PA
This page provides the complete NPI Profile along with additional information for Hattiesburg Clinic Pa, a provider established in Hattiesburg, Mississippi operating as a Clinic/center, focusing in adolescent and children mental health . The healthcare provider is registered in the NPI registry with number 1154410017 assigned on October 2006. The practitioner's primary taxonomy code is 261QM0855X. The provider is registered as an organization and their NPI record was last updated May 2025. The provider's
- NPI
- 1154410017
- Provider Legal Name
- HATTIESBURG CLINIC PA
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 102 MEDICAL PARK HATTIESBURG, MS 39401
- Location Phone
- (601) 261-5159
- Location Fax
- (601) 545-1740
- Mailing Address
- 415 S 28TH AVE HATTIESBURG, MS 39401
- Mailing Phone
- (601) 579-5488
- Mailing Fax
- (601) 545-1740
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-11-2006
- Last Update Date
- 05-28-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Adolescent and Children Mental Health
- Taxonomy Code
- 261QM0855X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Connect Bronze 5500 Indiv Med Deductible Enhanced Diabetes Care - EPO
- Connect Bronze 6500 Indiv Med Deductible - EPO
- Connect Bronze 8500 Indiv Med Deductible - EPO
- Connect Bronze CMS Standard - EPO
- Connect Gold 2000 Indiv Med Deductible - EPO
- Connect Gold CMS Standard - EPO
- Connect Silver 3800 Indiv Med Deductible Enhanced Diabetes Care - EPO
- Connect Silver 4000 Indiv Med Deductible - EPO
- Connect Silver 6500 Indiv Med Deductible - EPO
- Connect Silver CMS Standard - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 09673755 | MEDICAID (05) | MS |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 25D2155784
- Facility Type
- Physician Office
- Certificate Effective Date
- October 04, 2024
- Certificate Expiration Date
- October 03, 2026
- Laboratory Director
- DR. RONALD S. KENT
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Hattiesburg Clinic Pa to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 5 | 4 | 4 | 1 | 0 | 0 | 1 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 10 | 4 | 8 | 1 | 0 | 0 | 2 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 1 + 0 + 4 + 8 + 1 + 0 + 0 + 2 + 24 = 43 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 43 = 7 | 7 | ||||||||
The NPI number 1154410017 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 17 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1154641108 | CAROL BENEDICT SIMMONS LPC Individual | Counselor (Professional) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1174566145 | ROBERT CHARLES SEVIER PHD Individual | Psychologist (Clinical) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1093745770 | LYNWOOD CLINTON WHEELER PHD Individual | Psychologist (Counseling) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1548425341 | JOSHUA RICHARD HAMM LPC Individual | Counselor (Professional) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1699913202 | MELANIE RAYE HAMM CPNP-PC Individual | Nurse Practitioner (Pediatrics) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1740500925 | KRYSTAL MASSEY DRAUGHN LCSW Individual | Social Worker (Clinical) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1609156116 | MELISSA CAROL SMITH FNP Individual | Nurse Practitioner (Family) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1588908545 | CARRIE ELLEN MORGAN PHD Individual | Psychologist (Clinical) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1215354691 | LAUREN ENGLISH P.A.-C Individual | Physician Assistant | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1134174097 | DR. ELIZABETH M FELDER MD Individual | Pediatrics | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1104979731 | TAMMARA ANN JORDAN M.S.,CCC-SLP Individual | Speech-Language Pathologist | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1962713297 | CATHRYNE E WELLS SLP Individual | Speech-Language Pathologist | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1831491687 | AMANDA LYNN GAY SLP Individual | Speech-Language Pathologist | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1093457988 | KAITLIN GRANBERRY CPNP-PC Individual | Nurse Practitioner | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1861932436 | ADRIENNE WHITTINGTON SLP Individual | Speech-Language Pathologist | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
| 1376308882 | MARSHALL HENRY KUHN LPC Individual | Counselor (Professional) | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-1650 |
| 1083246474 | JENNIFER ROSS GOODWIN PNP-PC Individual | Nurse Practitioner | 102 MEDICAL PARK HATTIESBURG, MS 39401 (601) 261-5159 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154410017, enumerated in the NPI registry as an "organization" on October 11, 2006
The provider is located at 102 Medical Park Hattiesburg, Ms 39401 and the phone number is (601) 261-5159
This medical organization specializes in Clinic/Center with taxonomy code 261QM0855X with a focus in Adolescent and Children Mental Health
The provider might be accepting Accepts: Cigna Healthcare, Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 25D2155784 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..
This NPI record was last updated on October 11, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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