Emmanuel Mendoza, PA-C
Individual provider Active NPI Physician Assistant · Vancleave, MS
NPI 1225856602 · NPPES record last updated Feb 25, 2025
Key facts
- NPI
- 1225856602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00846 (MS)
- Practice address
- 6300 E Lake Blvd Ste 201
Vancleave, MS 39565-6771 - Phone
- (228) 230-2663
- NPI assigned
- Oct 2, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bienville Orthopaedic Specialists, LLC
Practice addresses (Care Compare)
1720 A Medical Park Dr
Suite 220
Biloxi, MS 39532-2127
Phone (228) 392-9355
3615 Hospital St
Pascagoula, MS 39581-4112
Phone (228) 762-3664
6300 E Lake Blvd
Vancleave, MS 39565-6771
Phone (228) 230-2663
Hospital & facility affiliations
- Singing River Gulfport
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250414002988 | MS | Practitioner - Physician Assistant | 5395269179 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bienville Orthopaedic Specialists, LLC | Current |
Accepting new patients | |
| Bienville Orthopaedic Specialists, LLC | Current |
Accepting new patients |
Locations
1720A Medical Park Dr
Ste 220
Biloxi, MS 39532
Phone (228) 392-9355
3615 Hospital St
Pascagoula, MS 39581
Phone (228) 762-3664
6300 E Lake Blvd
Ste 201
Vancleave, MS 39565
Phone (228) 206-2263
6300 E Lake Blvd
Ste 301
Vancleave, MS 39565
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00846 | MS | Yes |
Addresses
Primary practice location
6300 E Lake Blvd Ste 201
Vancleave, MS 39565-6771
Mailing address
6300 E Lake Blvd Ste 301
Vancleave, MS 39565-6771
Phone (228) 230-2663
Other practice location 1
3615 Hospital St
Pascagoula, MS 39581-4112
Phone (228) 230-2663
Other names
- Manny Mendoza
Other providers in Vancleave, MS
- Massage Connexion, LLC
- Brittany McElhaney
- Naomi Ann McKneely
- Reagan McMurtery
- Maryann Meehan
- Whitney W Moore
- Danny Nguyen
- Harrison Olinger
- Natalie Overstreet
- Sarah Carter Pannell
All providers in Vancleave, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.