Organization Active NPI

NP on Call

Doing business as NP Family Medical Clinic

  • Family Medicine Physician
  • Gulfport, MS
National Provider Identifier
1255713889
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NP ON CALL
Doing business as
NP Family Medical Clinic
Practice address
2300 24TH Ave
Gulfport, MS 39501
Phone
(228) 206-6500
Fax
(866) 659-9359
NPI assigned
Jun 19, 2015
Organization subpart
Yes
Parent organization
NP ON CALLAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Carricka Thomas, FNP-BCNPI 1538469689
Title
Nurse Practitioner
Phone
(228) 326-9951

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2300 24TH Ave
Gulfport, MS 39501

Mailing address

2300 24TH Ave
Gulfport, MS 39501-4605
Phone (228) 206-6500

Other names 1

  • NP Family Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160229002693 MS Part B Supplier - Clinic/Group Practice 0042515009 Receives reassigned benefits from 2 practitioners
Practice locations: Gulfport, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2100623MRH Medical Group, NP Family Medical Clinic2300 24TH Ave, Gulfport, MS 39501Certificate of waiverAug 17, 2027

National Provider Directory

National Provider Directory
Part of
NP on Call

Locations

12451 Dedeaux Rd
Gulfport, MS 39503

2300 24th Ave
Gulfport, MS 39501
Phone (228) 206-6500

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1255713889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 24TH AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395014605",
            "telephone_number": "228-206-6500",
            "fax_number": "866-659-9359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 24TH AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39501",
            "telephone_number": "228-206-6500",
            "fax_number": "866-659-9359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NP ON CALL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NP ON CALL",
        "enumeration_date": "2015-06-19",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "CARRICKA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "228-326-9951",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NP Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NP Family Medical Clinic",
            "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 Dec 3, 2024; 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.