Active NPI
Memorial Hospital at Gulfport
- Family Medicine Physician
- Gulfport, MS
National Provider Identifier
1205129137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MEMORIAL HOSPITAL AT GULFPORT
- Practice address
- 20006 Hwy 53
7 Sunshine Place
Gulfport, MS 39503-0000 - Phone
- (228) 867-3106
- NPI assigned
- May 25, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jeff T Steiner
- Title
- VP of Finance
- Phone
- (228) 865-3469
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
20006 Hwy 53
7 Sunshine Place
Gulfport, MS 39503-0000
Mailing address
PO Box 555
Biloxi, MS 39533-0555
Phone (228) 575-1730
Other names 1
- Physicians Clinic at MHG
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080515000774 | MS | Part A Provider - Hospital | 9537062997 | This NPI is an additional NPI on the enrollment |
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
- Enrollment address
- 4500 13TH St
Gulfport, MS 39501-2515 - Hospital subgroups
- Acute care
Care Compare: Hospital
Medicare Care Compare- Listed as
- Memorial Hospital at Gulfport
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Ajm Oustalet | Corporate Officer | Mar 1, 2009 | 5% |
| Peggy L Noonan | Corporate Director | May 1, 2020 | 5% |
| W-2 Managing Employee | Jan 1, 2006 | 5% | |
| Kent Nicaud | Corporate Director | Nov 1, 2008 | |
| W-2 Managing Employee | Nov 1, 2008 | ||
| Thaddeus Carter | Corporate Officer | Aug 1, 2017 | 5% |
| Claire Tindell | Corporate Officer | Jan 1, 2019 | 5% |
| Harrison County Board of Supervisors | 5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Carrolyn Hamilton | Corporate Director | Aug 10, 2009 | |
| David H White | Corporate Director | Sep 17, 1993 | |
| City of Gulfport | 5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Jennifer Dumal | W-2 Managing Employee | Feb 8, 1998 | |
| Carlos Bell | Corporate Officer | Nov 26, 2018 | 5% |
Practitioners & affiliated clinicians
Affiliated clinicians 765
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Hospitalist Physician
- Gulfport, MS
- NPI 1730491036
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306281600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1306281600000",
"number": "1205129137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 555",
"city": "BILOXI",
"state": "MS",
"postal_code": "395330555",
"telephone_number": "228-575-1730",
"fax_number": "228-575-1735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20006 HWY 53",
"address_2": "7 SUNSHINE PLACE",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395030000",
"telephone_number": "228-867-3106"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
"organizational_subpart": "NO",
"enumeration_date": "2011-05-25",
"last_updated": "2011-05-25",
"status": "A",
"authorized_official_last_name": "STEINER",
"authorized_official_first_name": "JEFF",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "VP OF FINANCE",
"authorized_official_telephone_number": "228-865-3469"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Physicians Clinic at MHG",
"code": "3",
"type": "Doing Business As"
}
]
}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 May 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.