Memorial Hospital at Gulfport
Organization Active NPI Pediatrics Physician · Gulfport, MS
NPI 1376874792 · NPPES record last updated Jan 3, 2011
Key facts
- NPI
- 1376874792
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- MEMORIAL HOSPITAL AT GULFPORT
- Practice address
- 1285 Spring St
Suite a
Gulfport, MS 39507-3423 - Phone
- (228) 896-6441
- Fax
- (228) 896-6576
- NPI assigned
- Jan 25, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeff T Steiner
- Title
- VP of Finance
- Phone
- (228) 865-3106
Practitioners 1
Affiliated clinicians 765
-
Lauren Ackerman, PA
-
Casey Adams, CNP
-
Daniel Adams, MD
-
Satjit Adlakha, D.O.
-
Ahmad Agha, M.B.B.S.
-
Belinda Alexander, M.D.
-
Amy Allen, CRNP
-
Summer Lea Allen, MD
-
Brian Thomas Anthony, M.D.
-
Lisa Yarborough Anthony, N.P.
-
Kathleen Cecilia Arnold, A.N.P.
-
Nabil Azar, M.D.
-
Lissa Kelly Baber, AGACNP
-
Seema Anil Badve, MD
-
Rainna P Bahadur, M.D.
-
Christine Tracey Balius, MSN, FNP-C
-
Anne Elizabeth Baranano, M.D.
Medicare Care Compare: Hospital
- Listed as
- Memorial Hospital at Gulfport
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Hospital certification: CCN 250019
- Legal name
- MEMORIAL HOSPITAL AT GULFPORT
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Aug 19, 2009
- Beds
- 445
- Ownership / control type
- Local
- Organization structure
- Other · Non-profit
- Enrollment address
- 4500 13TH St
Gulfport, MS 39501-2515 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Ajm Oustalet |
Corporate Officer |
Mar 1, 2009 | 5% |
| Peggy L Noonan |
Corporate Director |
May 1, 2020 | 5% |
| W-2 Managing Employee |
Jan 1, 2006 | 5% | |
| Kent Nicaud |
Corporate Director |
Nov 1, 2008 | |
| W-2 Managing Employee |
Nov 1, 2008 | ||
| Thaddeus Carter |
Corporate Officer |
Aug 1, 2017 | 5% |
| Claire Tindell |
Corporate Officer |
Jan 1, 2019 | 5% |
| Harrison County Board of Supervisors |
5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Carrolyn Hamilton |
Corporate Director | Aug 10, 2009 | |
| David H White |
Corporate Director | Sep 17, 1993 | |
| City of Gulfport |
5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Jennifer Dumal |
W-2 Managing Employee | Feb 8, 1998 | |
| Carlos Bell |
Corporate Officer |
Nov 26, 2018 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080515000774 | MS | Part a Provider - Hospital | 9537062997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
835 Thames Ave
Ste A
Bay St Louis, MS 39520
Phone (228) 463-0824
618 Blue Meadow Rd
Ste 20
Bay St Louis, MS 39520
Phone (228) 463-0824
300 Drinkwater Rd
Bay St Louis, MS 39520
Phone (228) 255-6868
4300 Leisure Time Dr
Ste B
Diamondhead, MS 39525
Phone (228) 255-6129
4300 W Railroad St
Gulfport, MS 39501
1340 Broad Ave
Ste 310
Gulfport, MS 39501
Phone (228) 575-1400
4540 W Railroad St
Gulfport, MS 39501
Phone (228) 867-2598
1340 Broad Ave
Ste 39501
Gulfport, MS 39501
1340 Broad Ave
Ste 300A
Gulfport, MS 39501
Phone (228) 297-5529
9350 Highway 49
#A
Gulfport, MS 39503
Phone (225) 563-6800
1240 Broad Ave
Ste 300
Gulfport, MS 39501
12100 Highway 49
Ste 318
Gulfport, MS 39503
4500 13th St
Ste 240
Gulfport, MS 39501
1340 Broad Ave
Ste 340
Gulfport, MS 39501
Phone (228) 575-1200
111 Omni Dr
Seneca, SC 29672
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
1285 Spring St
Suite a
Gulfport, MS 39507-3423
Mailing address
PO Box 555
Biloxi, MS 39533-0555
Phone (228) 864-0854
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02874208 | Medicaid | MS |
Other names
- PHYSICIANS CLINIC AT MHG
Other providers in Gulfport, MS
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
All providers in Gulfport, MS · Pediatrics Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2011. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.