NPIMap

Individual provider Active NPI

Charles A Stanich, M.D.

  • Internal Medicine Physician
  • Gulfport, MS
National Provider Identifier
1356424576
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
19513 Issued in MS
Practice address
4500 13TH Street
Gulfport, MS 39501
Phone
(228) 867-4396
Fax
(228) 867-5354
NPI assigned
Oct 23, 2006
Last updated
Sep 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 19513 MS
Internal Medicine Physician 207R00000X 19513 MS Primary

Addresses

Primary practice location

4500 13TH Street
Gulfport, MS 39501

Mailing address

PO Box 1810
Gulfport, MS 39502
Phone (228) 575-1194

Other identifiers 1

IdentifierTypeStateIssuer
646000515EOtherMSBLUE CROSS OF MS

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
I20070104000171 MS Practitioner - Internal Medicine 3577563139 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians
GSW Medical LLCGroup PAC ID 1850779307, 4 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

1440 Central Ave E
Wiggins, MS 39577-9602
Phone (601) 928-6700

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 218-2226

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
19513MSMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kings Daughters Medical Center Current Accepting new patients
Singing River Health System CurrentSince Oct 9, 2006 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Jul 1, 2016 Accepting new patients
Singing River Health System Internal Medicine CurrentSince Oct 9, 2006 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Care Doc LLC Internal Medicine Current Accepting new patients
Caredoc LLC CurrentSince May 24, 2023 Accepting new patients
GSW Medical, LLC Internal Medicine CurrentSince Jun 1, 2022 Accepting new patients
King's Daughters Medical Center CurrentSince Sep 26, 2014 Accepting new patients
King's Daughters Medical Center CurrentSince Sep 26, 2014 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
Select Specialty Hospital - Gulf Coast Inc Past Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
Lakeview Corporation Past Accepting new patients

Locations

427 Highway 51 N
Brookhaven, MS 39601
Phone (601) 833-6011

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

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

1199 Ocean Springs Rd
Ocean Springs, MS 39564
Phone (228) 875-9363

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 65

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

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1356424576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39502",
            "telephone_number": "228-575-1194",
            "fax_number": "228-575-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 13TH STREET",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39501",
            "telephone_number": "228-867-4396",
            "fax_number": "228-867-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANICH",
        "first_name": "CHARLES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MS",
            "license": "19513",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "19513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MS",
            "identifier": "646000515E",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.