NPIMap

Individual provider Active NPI

John Pavlov, M.D.

  • Family Medicine Physician
  • Pascagoula, MS
National Provider Identifier
1124179791
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11764 Issued in MS
Practice address
2819 Denny Ave
Pascagoula, MS 39581-5301
Phone
(228) 762-3466
Fax
(228) 762-6349
NPI assigned
Jan 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MS11764 MS
Family Medicine Physician 207Q00000X 11764 MS Primary

Addresses

Primary practice location

2819 Denny Ave
Pascagoula, MS 39581-5301

Mailing address

2101 Highway 90
Gautier, MS 39553-5340

Other identifiers 5

IdentifierTypeStateIssuer
00012527MedicaidMS
080186277OtherMEDICARE RAILROAD
646000515OtherTRICARE
646000515OtherBLUE CROSS OF MS
009928105MedicaidAL

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
I20100728000252 MS Practitioner - General PracticePractitioner - Emergency Medicine 1759414766 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Emergency Medicine
Education
University of Mississippi School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

2819 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 762-3466

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MS11764MSMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Room Group LTD Emergency Medicine CurrentSince Feb 15, 2015 Accepting new patients
Singing River Gulfport CurrentSince Jan 4, 2022 Accepting new patients
Singing River Gulfport Emergency Medicine CurrentSince Jan 4, 2022 Accepting new patients
Singing River Hospital System Past Accepting new patients

Locations

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

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

Networks

  • LA PPO C-SNP

Organizations & group practices 5

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 63

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

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1124179791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2819 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815301",
            "telephone_number": "228-762-3466",
            "fax_number": "228-762-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLOV",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "MS11764",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "11764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00012527",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080186277",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "646000515",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MS",
            "identifier": "646000515",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009928105",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

Verify at the official NPI Registry.