NPIMap

Individual provider Active NPI

Jared J Deloach II, NP

  • Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1235766304
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
903846 Issued in MS
Practice address
1391 Broad Ave Ste a
Gulfport, MS 39501-2419
Phone
(228) 863-8868
NPI assigned
Mar 26, 2020
Last updated
Mar 26, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 903846 MS Primary

Addresses

Primary practice location

1391 Broad Ave Ste a
Gulfport, MS 39501-2419

Mailing address

1391 Broad Ave Ste a
Gulfport, MS 39501-2419
Phone (228) 863-8868

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
I20200501001746 MS Practitioner - Nurse Practitioner 5597196782 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1391 Broad Ave
Suite a
Gulfport, MS 39501-2419
Phone (228) 863-8868

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Nurse Practitioner CurrentSince Apr 13, 2020 Accepting new patients
Forever Young Mens Health Clinic PLLC CurrentSince May 1, 2024 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Apr 13, 2020 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
Action Potential, PLLC PastSince May 1, 2024 Accepting new patients

Locations

835 Thames Ave
Bay St Louis, MS 39520
Phone (228) 466-4977

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

1391 Broad Ave
Ste A
Gulfport, MS 39501
Phone (228) 669-6328

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

8837 Lorraine Rd
Ste A
Gulfport, MS 39503
Phone (228) 241-1000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1235766304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 BROAD AVE STE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012419",
            "telephone_number": "228-863-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1391 BROAD AVE STE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012419",
            "telephone_number": "228-863-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELOACH",
        "first_name": "JARED",
        "middle_name": "J",
        "name_suffix": "II",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "903846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.