NPIMap

Organization Active NPI

TBD Acquisition II, LLC

Doing business as Gulfport Behavioral Health System

  • Clinical Social Worker
  • Gulfport, MS
National Provider Identifier
1003324419
Registry record updated Jan 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
TBD ACQUISITION II, LLC
Doing business as
Gulfport Behavioral Health System
Practice address
11150 Highway 49 Ste B
Gulfport, MS 39503-4110
Phone
(228) 867-5202
NPI assigned
Jan 19, 2018
Last updated
Jan 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2018

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

Authorized official

Name
Steve Filton
Title
Sr VP Cfo
Phone
(610) 768-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X MS Primary

Addresses

Primary practice location

11150 Highway 49 Ste B
Gulfport, MS 39503-4110

Mailing address

11150 Highway 49
Gulfport, MS 39503-4110

Other names 1

  • Gulfport Behavioral Health System Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171012000543 MS Part A Provider - Hospital 7911272257 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gulfport, MS
O20171219001761 MS Part B Supplier - Clinic/Group Practice 7911272257 Receives reassigned benefits from 50 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gulfport, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003324419. Details of each certification follow.

Hospital certification: CCN 254011

Legal name
TBD ACQUISITION II LLC
Doing business as
GULFPORT BEHAVIORAL HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Apr 25, 2018
Last certification
Apr 25, 2018
Beds
109
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jul 18, 2017 in DE
Enrollment address
11150 Highway 49
Gulfport, MS 39503-4110
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Gulfport Behavioral Health SystemCCN 254011 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
TBD Acquisition II LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1340 Broad Ave
Ste 410
Gulfport, MS 39501
Phone (228) 575-1775

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
George H Brunner Individual Corporate OfficerAssistant Secretary Dec 1, 2017 100%
Katharine M Lyver Individual Corporate OfficerVice President Jan 1, 2024 100%
Matthew D Klein Individual Corporate OfficerSecretary Dec 1, 2017 100%
Matthew J Peterson Individual Corporate OfficerPresident Sep 19, 2019 100%
Corporate DirectorPresident Sep 19, 2019 33.3%
Operational/Managerial ControlPresident Sep 19, 2019 100%
Thomas M Day Individual Corporate OfficerVice President Jul 21, 2021 100%
Corporate DirectorVice President Jul 21, 2021 33.3%
Steve Filton Individual Corporate OfficerVP Dec 1, 2017 100%
Corporate DirectorVP Dec 1, 2017 33.3%
Operational/Managerial ControlVP Dec 1, 2017 100%
Cheryl K Ramagano Individual Corporate OfficerTreasurer Dec 1, 2017 100%
Universal Health Services Inc Organization, King of Prussia, PA Corporation 5% Or Greater Direct Ownership Interest Dec 1, 2017 100%
James M Coleman Individual Contracted Managing EmployeeSenior Reimbursement Manager Dec 1, 2017 50%
Dean S Doty Individual Contracted Managing EmployeeCeo Jan 3, 2023
Corporate OfficerCeo Jan 3, 2023
Uhs of Delaware Inc Organization, King of Prussia, PA Corporation Operational/Managerial Control Dec 1, 2017 100%
David S Cichocki Individual Contracted Managing EmployeeCfo Apr 23, 2023
Corporate OfficerCfo Apr 23, 2023
Alan B Miller Individual 5% Or Greater Indirect Ownership InterestChairman Mar 25, 2022 86.5%

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1516320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516320000000",
    "number": "1003324419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11150 HIGHWAY 49",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11150 HIGHWAY 49 STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034110",
            "telephone_number": "228-867-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TBD ACQUISITION II, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-19",
        "last_updated": "2018-01-19",
        "status": "A",
        "authorized_official_last_name": "FILTON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "SR VP CFO",
        "authorized_official_telephone_number": "610-768-3300"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulfport Behavioral Health System",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.