NPIMap

Individual provider Active NPI

Stephanie Fussell, M.D.

  • Medical Oncology Physician
  • Gulfport, MS
National Provider Identifier
1073569018
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
16995 Issued in MS
Practice address
1340 Broad Ave Ste 330
Gulfport, MS 39501-2464
Phone
(228) 575-1234
Fax
(282) 865-3038
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 16995 MS
Hematology & Oncology Physician 207RH0003X 00025974 AL
Medical Oncology Physician 207RX0202X 16995 MS Primary

Addresses

Primary practice location

1340 Broad Ave Ste 330
Gulfport, MS 39501-2464

Mailing address

PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 575-1234

Other identifiers 4

IdentifierTypeStateIssuer
P00122585OtherALMEDICARE RAILROAD
529501680MedicaidAL
51523039OtherALBLUE CROSS ID#
00236384MedicaidMS

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
I20090106000397 MS Practitioner - Medical Oncology 8628052453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
Louisiana State University School of Medicine in New Orleans, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2464

1340 Broad Ave
Gulfport, MS 39501-2465

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152

835 Thames Ave
Bay St Louis, MS 39520-5005
Phone (228) 466-4977

920 Tommy Munro Dr
Suite 100
Biloxi, MS 39532-2150
Phone (228) 575-1800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00025974ALMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport CurrentSince Mar 15, 2014 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport Hematology & Oncology CurrentSince Mar 15, 2014 Accepting new patients
Oncology Specialties, P.C. Hematology & Oncology Past Accepting new patients

Locations

1756 Popps Ferry Rd
Ste A
Biloxi, MS 39532
Phone (228) 865-3200

1340 Broad Ave
Ste 210
Gulfport, MS 39501
Phone (228) 575-1600

1340 Broad Ave
Ste 330
Gulfport, MS 39501
Phone (228) 575-1234

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

1340 Broad Ave
Ste 270
Gulfport, MS 39501
Phone (228) 575-1234

1340 Broad Ave
#270
Gulfport, MS 39501

Networks

  • LA PPO C-SNP

Interoperability endpoints

  • Direct secure messaging: sfussell@direct.mhg.com

Organizations & group practices 4

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

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1073569018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395021810",
            "telephone_number": "228-575-1234",
            "fax_number": "228-575-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE STE 330",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012464",
            "telephone_number": "228-575-1234",
            "fax_number": "282-865-3038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSSELL",
        "first_name": "STEPHANIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "MS",
            "license": "16995",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "AL",
            "license": "00025974",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MS",
            "license": "16995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00122585",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529501680",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID#",
            "identifier": "51523039",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00236384",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.