NPIMap

Organization Active NPI

Memorial Hospital at Gulfport

  • General Acute Care Hospital
  • Gulfport, MS
National Provider Identifier
1073606901
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
MEMORIAL HOSPITAL AT GULFPORT
Practice address
4500 13TH St
Gulfport, MS 39501-2515
Phone
(228) 867-3076
Fax
(228) 865-3098
NPI assigned
Oct 2, 2006
Last updated
Jan 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

Name
Mr. Kent Nicaud
Title
Ceo
Phone
(228) 865-3076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

4500 13TH St
Gulfport, MS 39501-2515

Mailing address

PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 867-3076

Other practice location 1

1434 Central Ave E
Wiggins, MS 39577-9602
Phone (601) 928-6600

Other identifiers 13

IdentifierTypeStateIssuer
000019027OtherMSBLUE CROSS
0250019MedicaidTN
027OtherMSBLUE CROSS BLUE SHIELD MS
901382200MedicaidFL
00020027MedicaidMS
CA1177OtherMSRAILROAD MEDICARE
MEM0019NMedicaidAL
000260081XMedicaidGA
1731625MedicaidLA
1887007MedicaidTN
C00042OtherMSCAHABA PROVIDER NUMBER
1943061MedicaidLA
374535800OtherMSUS DEPT OF LABOR NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080515000774 MS Part A Provider - Hospital 9537062997 This NPI is an additional NPI on the enrollment
O20090515000396 MS Part B Supplier - Clinic/Group Practice 2466524012 Receives reassigned benefits from 753 practitioners
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073606901. Details of each certification follow.

Hospital certification: CCN 250019

Legal name
MEMORIAL HOSPITAL AT GULFPORT
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 19, 2009
Beds
445
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
4500 13TH St
Gulfport, MS 39501-2515
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial Hospital at GulfportCCN 250019 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations (25 of 60)

1001 Benigno Ln
Bay St Louis, MS 39520
Phone (228) 467-1414

835 Thames Ave
Ste A
Bay St Louis, MS 39520
Phone (228) 463-0824

952 Green Meadow Rd
Bay St Louis, MS 39520
Phone (228) 463-1649

14209 Cook Rd
Biloxi, MS 39532
Phone (228) 575-2536

14209 Cook Rd
#100
Biloxi, MS 39532
Phone (228) 575-2474

1720 Medical Park Dr
Ste 300
Biloxi, MS 39532
Phone (228) 702-1507

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

189-C Walmart Ln
Biloxi, MS 39531
Phone (228) 575-2680

2781 C T Switzer SR Dr
Ste 305
Biloxi, MS 39531

2781 C T Switzer SR Dr
Ste 404
Biloxi, MS 39531
Phone (228) 205-3676

676 Bayview Ave
Biloxi, MS 39530
Phone (228) 436-8990

920 Tommy Munro Dr
Ste 100
Biloxi, MS 39532
Phone (228) 575-1234

920 Tommy Munro Dr
Ste 200
Biloxi, MS 39532
Phone (228) 575-1180

971 Tommy Munro Dr
Biloxi, MS 39532
Phone (228) 207-1777

971 Tommy Munro Dr
Ste C
Biloxi, MS 39532
Phone (228) 207-1777

4300 Leisure Time Dr
Ste B
Diamondhead, MS 39525
Phone (228) 255-6129

6510 Highway 90
Gautier, MS 39553
Phone (228) 864-3300

6510 Highway 90
#A
Gautier, MS 39553
Phone (228) 822-6148

726 Highway 90
Ste E
Gautier, MS 39553
Phone (228) 497-2334

1110 Broad Ave
Ste 400
Gulfport, MS 39501
Phone (228) 864-0092

1110 Broad Ave
Ste B
Gulfport, MS 39501

11150 Highway 49
Gulfport, MS 39503
Phone (228) 575-1000

1201 31st Ave
Gulfport, MS 39501
Phone (228) 284-2177

12100 Highway 49
Ste 316
Gulfport, MS 39503

1285 Spring St
Ste A
Gulfport, MS 39507
Phone (228) 896-6441

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Ajm Oustalet Individual Corporate OfficerBoard Member Mar 1, 2009 5%
Peggy L Noonan Individual Corporate DirectorDirector, Business Services May 1, 2020 5%
W-2 Managing EmployeeDirector, Business Services Jan 1, 2006 5%
Kent Nicaud Individual Corporate DirectorChief Executive Officer Nov 1, 2008
W-2 Managing EmployeeCeo Nov 1, 2008
Thaddeus Carter Individual Corporate OfficerBoard Member Aug 1, 2017 5%
Claire Tindell Individual Corporate OfficerBoard Member Jan 1, 2019 5%
Harrison County Board of Supervisors Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Carrolyn Hamilton Individual Corporate Director Aug 10, 2009
David H White Individual Corporate Director Sep 17, 1993
City of Gulfport Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Jennifer Dumal Individual W-2 Managing Employee Feb 8, 1998
Carlos Bell Individual Corporate OfficerBoard Secretary Nov 26, 2018 5%

Practitioners & affiliated clinicians

Practitioners 344

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 344

Affiliated clinicians 765

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 765

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1073606901",
    "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": "228-867-3076",
            "fax_number": "228-865-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 13TH ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012515",
            "telephone_number": "228-867-3076",
            "fax_number": "228-865-3098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1434 Central Ave E",
            "address_purpose": "LOCATION",
            "city": "Wiggins",
            "state": "MS",
            "postal_code": "395779602",
            "country_code": "US",
            "telephone_number": "601-928-6600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "NICAUD",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-865-3076",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000019027",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0250019",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MS",
            "identifier": "027",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "901382200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00020027",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA1177",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MEM0019N",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000260081X",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1731625",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1887007",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAHABA PROVIDER NUMBER",
            "identifier": "C00042",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1943061",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR NUMBER",
            "identifier": "374535800",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.