Grace P Ford, FNP-BC
Individual provider Active NPI Nurse Practitioner · Poplarville, MS
NPI 1376815134 · NPPES record last updated Nov 25, 2020
Key facts
- NPI
- 1376815134
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 875721 (MS)
- Practice address
- 302 Highway 11 S
Poplarville, MS 39470-2625 - Phone
- (601) 403-8283
- Fax
- (601) 403-8283
- NPI assigned
- Feb 8, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 60
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Memorial Hospital at Gulfport
Practice addresses (Care Compare)
1340 Broad Ave
Suite 410
Gulfport, MS 39501-2459
Phone (228) 867-5202
Hospital & facility affiliations
- Memorial Hospital at 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 |
|---|---|---|---|---|
| I20120322000665 | MS | Practitioner - Nurse Practitioner | 5496915753 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 875721 | MS | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital at Gulfport | Current |
Accepting new patients | |
| Forrest County General Hospital | Current |
Accepting new patients | |
| Pearl River County Hospital | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Past | Accepting new patients |
Locations
1340 Broad Ave
Ste 410
Gulfport, MS 39501
Phone (228) 575-1775
1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856
302 Highway 11 S
Poplarville, MS 39470
Phone (601) 403-8284
305 W Moody St
#H
Poplarville, MS 39470
Phone (601) 795-4345
305 W Moody St
Poplarville, MS 39470
Phone (601) 795-4345
Interoperability endpoints
- grace.ford@direct.mhg.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 875721 | MS | Yes |
Addresses
Primary practice location
302 Highway 11 S
Poplarville, MS 39470-2625
Mailing address
305 W Moody St
Poplarville, MS 39470-7338
Phone (601) 795-4543
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12346339 | Other | MS | CAQH |
| 9858831 | Other | MS | AETNA |
| 07509343 | Medicaid | MS |
Other names
- Grace P O'Hara
Other providers in Poplarville, MS
- Encore Rehabilitation Inc
- Haley Kim Fagan
- Alise R Fairley
- Family Drug Mart of Poplarville,LLC
- Morgan J Farmer
- Forever Home Services
- Forrest County General Hospital
- Forrest County General Hospital
- Forrest County General Hospital
- Forrest County General Hospital
All providers in Poplarville, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2020. 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.