NPIMap

Individual provider Active NPI

Juanita Derouen, CRNA

  • Anesthesiology Physician
  • Gulfport, MS
National Provider Identifier
1124107388
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
R848958 Issued in MS
Practice address
4500 13TH St
Gulfport, MS 39501-2515
Phone
(228) 818-0563
Fax
(228) 818-0519
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X R848958 MS Primary

Addresses

Primary practice location

4500 13TH St
Gulfport, MS 39501-2515

Mailing address

22 Doctors Dr
Suite C
Ocean Springs, MS 39564
Phone (228) 818-0563

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070308000537 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 7618070848 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians
Etas PLLCGroup PAC ID 8123481934, 43 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Jackson County Anesthesia Anesthesiology CurrentSince Jan 23, 2023 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Mar 15, 2014 Accepting new patients
Best Anesthesia, PLLC Anesthesiology CurrentSince Jan 1, 2023 Accepting new patients
Memorial Hospital at Gulfport Anesthesiology CurrentSince Mar 15, 2014 Accepting new patients
Etas, PLLC Anesthesiology CurrentSince Aug 1, 2023 Accepting new patients

Locations

7956 Vaughn Rd
Ste 165
Montgomery, AL 36116

150 Reynoir St
Biloxi, MS 39530
Phone (228) 432-7817

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

4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451

4500 13th St
Fl 2
Gulfport, MS 39501
Phone (228) 865-3281

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

22 Doctors Dr
#C
Ocean Springs, MS 39564
Phone (678) 553-8150

3882 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 872-6290

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Interoperability endpoints

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

Organizations & group practices 6

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 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124107388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 DOCTORS DR",
            "address_2": "SUITE C",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "39564",
            "telephone_number": "228-818-0563",
            "fax_number": "228-818-0519"
        },
        {
            "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": "228-818-0563",
            "fax_number": "228-818-0519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROUEN",
        "first_name": "JUANITA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "R848958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.