NPIMap

Individual provider Active NPI

Lissa Kelly Baber, AGACNP

  • Acute Care Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1306409040
Registry record updated Jun 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
903259 Issued in MS
Practice address
1340 Broad Ave
Gulfport, MS 39501-2404
Phone
(228) 867-5012
NPI assigned
Apr 18, 2019
Last updated
Jun 30, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 903259 MS Primary

Addresses

Primary practice location

1340 Broad Ave
Gulfport, MS 39501-2404

Mailing address

5 Oak Alley LN
Long Beach, MS 39560-8000
Phone (601) 433-0575

Other practice location 1

4500 13th St
Gulfport, MS 39501-2569
Phone (228) 867-4000

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
I20190715000430 MS Practitioner - Nurse Practitioner 3577898501 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Exceed Physical Therapy, LLCGroup PAC ID 8123378338, 72 clinicians
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

12261 Hwy 49
Suite 1
Gulfport, MS 39503-2976
Phone (228) 265-7185

1340 Broad Ave
Suite 450
Gulfport, MS 39501-2460
Phone (228) 867-5006

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
903259MSMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Single Specialty Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince May 13, 2019 Accepting new patients
Memorial Hospital at Gulfport Single Specialty CurrentSince May 13, 2019 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

1340 Broad Ave
Gulfport, MS 39501
Phone (228) 575-2902

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

1340 Broad Ave
Ste 450
Gulfport, MS 39501
Phone (228) 867-5006

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

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 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561852800000",
    "number": "1306409040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 OAK ALLEY LN",
            "city": "LONG BEACH",
            "state": "MS",
            "postal_code": "395608000",
            "telephone_number": "601-433-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012404",
            "telephone_number": "228-867-5012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 13th St",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "395012569",
            "country_code": "US",
            "telephone_number": "228-867-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BABER",
        "first_name": "LISSA",
        "middle_name": "KELLY",
        "credential": "AGACNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "903259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.