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Memorial Hospital at Gulfport

Organization Active NPI General Acute Care Hospital · Gulfport, MS

NPI 1073606901 · NPPES record last updated Jan 9, 2024

Key facts

NPI
1073606901
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 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
Organization subpart
No

Authorized official

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 334

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 334

Affiliated clinicians 765

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

View all 765

Medicare Care Compare: Hospital

Listed as
Memorial Hospital at Gulfport CCN 250019
Overall star rating
★★★☆☆ 3 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

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
Other · Non-profit
Enrollment address
4500 13TH St
Gulfport, MS 39501-2515
Hospital subgroups
Acute care

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 Officer
Board Member		 Mar 1, 2009 5%
Peggy L Noonan
Individual 		Corporate Director
Director, Business Services		 May 1, 2020 5%
W-2 Managing Employee
Director, Business Services		 Jan 1, 2006 5%
Kent Nicaud
Individual 		Corporate Director
Chief Executive Officer		 Nov 1, 2008
W-2 Managing Employee
Ceo		 Nov 1, 2008
Thaddeus Carter
Individual 		Corporate Officer
Board Member		 Aug 1, 2017 5%
Claire Tindell
Individual 		Corporate Officer
Board 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 Officer
Board Secretary		 Nov 26, 2018 5%

Medicare enrollment records

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

National Provider Directory

Locations (25 of 53)

833 Highway 90
Ste 1
Bay St Louis, MS 39520
Phone (228) 575-2828

1009 Benigno Ln
Bay St Louis, MS 39520
Phone (228) 467-2555

179 Drinkwater Rd
Bay St Louis, MS 39520
Phone (228) 395-1234

784 Vieux Marche Mall
Biloxi, MS 39530
Phone (228) 374-2575

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

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

147 Reynoir St
Ste 102
Biloxi, MS 39530
Phone (228) 374-3749

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

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

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

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

147 Reynoir St
Ste 201
Biloxi, MS 39530
Phone (228) 436-1348

920 Tommy Munro Dr
Biloxi, MS 39532
Phone (228) 392-7046

14213 Cook Rd
Bldg A
Biloxi, MS 39532
Phone (228) 575-2545

4363 Leisure Time Dr
#C
Diamondhead, MS 39525
Phone (228) 575-2597

45000 E Aloha Dr
Ste A
Diamondhead, MS 39525
Phone (228) 822-6006

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

1340 Broad Ave
Ste 270330
Gulfport, MS 39501

9424 Three Rivers Rd
#A
Gulfport, MS 39503
Phone (228) 575-2156

1110 Broad Ave
Ste 220
Gulfport, MS 39501

9344 Three Rivers Rd
Gulfport, MS 39503
Phone (228) 863-0500

10051 Lorraine Rd
Ste A
Gulfport, MS 39503
Phone (228) 539-7762

4500 13th St
Fl Main
Gulfport, MS 39501

4500 13th St
Ste 410
Gulfport, MS 39501

1404 44th Ave
Gulfport, MS 39501
Phone (228) 575-2870

Specialties & licenses

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

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

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

Electronic endpoints

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

Other providers in Gulfport, MS

All providers in Gulfport, MS · General Acute Care Hospital in Mississippi

Sources for this page

Verify at the official NPI Registry.