NPIMap

Organization Active NPI

Memorial Hospital at Gulfport

Doing business as Memorial Stone County Medical Center

  • Family Medicine Physician
  • Wiggins, MS
National Provider Identifier
1104477710
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEMORIAL HOSPITAL AT GULFPORT
Doing business as
Memorial Stone County Medical Center
Practice address
1440 Central Ave E
Wiggins, MS 39577-9602
Phone
(601) 928-6600
Fax
(601) 928-6610
NPI assigned
Sep 25, 2019
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
Peggy Lorraine Noonan
Title
Physician Business Services Dir.
Phone
(228) 575-1740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1440 Central Ave E
Wiggins, MS 39577-9602

Mailing address

1440 Central Ave E
Wiggins, MS 39577-9602
Phone (601) 928-6600

Other names 1

  • Memorial Stone County Medical Center Doing business as

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 1104477710. 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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1028769Memorial Stone County Medical Center1440 East Central Ave, Wiggins, MS 39577Certificate of waiverMar 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hospital21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

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 20

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 20

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": "1569369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1104477710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 CENTRAL AVE E",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395779602",
            "telephone_number": "601-928-6600",
            "fax_number": "601-928-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 CENTRAL AVE E",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395779602",
            "telephone_number": "601-928-6600",
            "fax_number": "601-928-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-25",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "NOONAN",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "LORRAINE",
        "authorized_official_title_or_position": "PHYSICIAN BUSINESS SERVICES DIR.",
        "authorized_official_telephone_number": "228-575-1740"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": [
        {
            "organization_name": "Memorial Stone County Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Stone County Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wiggins, MS

Sources for this page

Verify at the official NPI Registry.