NPIMap

Individual provider Active NPI

Matthew Blanchard, MD

  • Interventional Pain Medicine Physician
  • Gulfport, MS
National Provider Identifier
1043741705
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
28793 Issued in MS
Practice address
15476 Dedeaux Rd Ste B
Gulfport, MS 39503-2637
Phone
(228) 230-2663
Fax
(228) 546-3257
NPI assigned
Mar 24, 2017
Last updated
May 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 28793 MS
Anesthesiology Physician 207L00000X T6835 TX
Pain Medicine (Anesthesiology) Physician 207LP2900X T6835 TX
Interventional Pain Medicine Physician 208VP0014X 28793 MS Primary
Interventional Pain Medicine Physician 208VP0014X T6835 TX

Addresses

Primary practice location

15476 Dedeaux Rd Ste B
Gulfport, MS 39503-2637

Mailing address

6300 E Lake Blvd Ste 301
Vancleave, MS 39565-6771
Phone (228) 230-2663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210927001519 MS Practitioner - Pain ManagementPractitioner - Anesthesiology 1557635414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
Louisiana State University School of Medicine in Shreveport, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

15476 Dedeaux Rd
Suite B
Gulfport, MS 39503-2637
Phone (228) 230-2663

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
74.91 of 100Reported as group
Quality
70.09
Promoting interoperability
95
Improvement activities
40
Cost
50.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T6835TXMDAnesthesiology Physician
28793MSMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bienville Orthopaedic Specialists, LLC CurrentSince Jun 1, 2024 Accepting new patients
Bienville Orthopaedic Specialists, LLC CurrentSince Jun 1, 2024 Accepting new patients

Locations

1720A Medical Park Dr
Ste 220
Biloxi, MS 39532
Phone (228) 392-9355

15476 Dedeaux Rd
#B
Gulfport, MS 39503
Phone (228) 679-3001

6300 E Lake Blvd
Ste 301
Vancleave, MS 39565

Networks

  • LA PPO C-SNP

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 61

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1043741705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 E LAKE BLVD STE 301",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395656771",
            "telephone_number": "228-230-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15476 DEDEAUX RD STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032637",
            "telephone_number": "228-230-2663",
            "fax_number": "228-546-3257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCHARD",
        "first_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-24",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "28793",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "T6835",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TX",
            "license": "T6835",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MS",
            "license": "28793",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "TX",
            "license": "T6835",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.