Active NPI
My Brother'S Keeper, Inc
- Clinic/Center
- Gulfport, MS
National Provider Identifier
1003582925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- MY BROTHER'S KEEPER, INC
- Practice address
- 1221 Bridge St
Gulfport, MS 39507-3506 - Phone
- (769) 216-2455
- NPI assigned
- Aug 19, 2021
- Organization subpart
- Yes
- Parent organization
- MY BROTHER'S KEEPER, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- June A Gipson
- Title
- President/Ceo
- Phone
- (769) 216-2455
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
1221 Bridge St
Gulfport, MS 39507-3506
Mailing address
1221 Bridge St
Gulfport, MS 39507-3506
Phone (769) 216-2455
Other names 1
- Open Arms - Gulfport
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130322000283 | MS | Part B Supplier - Clinic/Group Practice | 4082859004 |
Receives reassigned benefits from 6 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gulfport, MS; Hattiesburg, MS; Jackson, MS |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- My Brother'S Keeper
- Part of
- My Brother'S Keeper
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Clinic/Center
- Jackson, MS
- NPI 1225628985
-
- Clinic/Center
- Hattiesburg, MS
- NPI 1215603139
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629331200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1629331200000",
"number": "1003582925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 BRIDGE ST",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395073506",
"telephone_number": "769-216-2455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 BRIDGE ST",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395073506",
"telephone_number": "769-216-2455"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MY BROTHER'S KEEPER, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MY BROTHER'S KEEPER, INC",
"enumeration_date": "2021-08-19",
"last_updated": "2021-08-19",
"certification_date": "2021-08-19",
"status": "A",
"authorized_official_last_name": "GIPSON",
"authorized_official_first_name": "JUNE",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "769-216-2455"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Open Arms - Gulfport",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.