NPIMap

Organization Active NPI

Gulf Coast Neurospa LLC

  • Psychiatry Physician
  • Gulfport, MS
National Provider Identifier
1013515451
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
GULF COAST NEUROSPA LLC
Practice address
8845 Lorraine Road
Gulfport, MS 39503
Phone
(228) 277-1771
Fax
(866) 740-0655
NPI assigned
Oct 16, 2020
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Authorized official

Name
Bryan Vyverberg, MDNPI 1740272723
Title
Owner
Phone
(228) 277-1771

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

8845 Lorraine Road
Gulfport, MS 39503

Mailing address

8845 Lorraine Road
Gulfport, MS 39503
Phone (228) 277-1771

Other names 1

  • Bridgewater TMS LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221202002848 MS Part B Supplier - Clinic/Group Practice 5092184622 Receives reassigned benefits from 4 practitioners
Practice locations: Gulfport, MS; Ocean Springs, MS
O20241023003173 FL Part B Supplier - Clinic/Group Practice 5092184622 Receives reassigned benefits from 2 practitioners
Practice locations: Pensacola, FL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1019 Government St
Ste E
Ocean Springs, MS 39564
Phone (228) 277-1771

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1013515451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8845 LORRAINE ROAD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39503",
            "telephone_number": "228-277-1771",
            "fax_number": "866-740-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8845 LORRAINE ROAD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39503",
            "telephone_number": "228-277-1771",
            "fax_number": "866-740-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST NEUROSPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-16",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "VYVERBERG",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-277-1771",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgewater TMS LLC",
            "code": "4",
            "type": "Former Legal Business 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 Apr 25, 2023; 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.