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Organization Active NPI

Memorial Hospital at Gulfport

Doing business as Physicians Clinic at MHG

  • Pediatrics Physician
  • Gulfport, MS
National Provider Identifier
1376874792
Registry record updated Jan 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MEMORIAL HOSPITAL AT GULFPORT
Doing business as
Physicians Clinic at MHG
Practice address
1285 Spring St
Suite a
Gulfport, MS 39507-3423
Phone
(228) 896-6441
Fax
(228) 896-6576
NPI assigned
Jan 25, 2010
Last updated
Jan 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2011

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

Authorized official

Name
Mr. Jeff T Steiner
Title
VP of Finance
Phone
(228) 865-3106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

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 1

IdentifierTypeStateIssuer
02874208MedicaidMS

Other names 1

  • PHYSICIANS CLINIC AT MHG Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080515000774 MS Part A Provider - Hospital 9537062997 This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376874792. Details of each certification follow.

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
OtherNon-profit
Enrollment address
4500 13TH St
Gulfport, MS 39501-2515
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial Hospital at GulfportCCN 250019 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1756 Popps Ferry Rd
Biloxi, MS 39532
Phone (228) 575-1800

1756 Popps Ferry Rd
Ste B
Biloxi, MS 39532
Phone (228) 575-1800

4300 Leisure Time Dr
Diamondhead, MS 39525
Phone (228) 255-4300

1110 Broad Ave
Ste 220
Gulfport, MS 39501

1240 Broad Ave
Ste 300
Gulfport, MS 39501

1340 Broad Ave
Ste 210
Gulfport, MS 39501
Phone (228) 575-1600

394 Courthouse Rd
Ste A
Gulfport, MS 39507
Phone (228) 896-4414

4300 W Railroad St
Gulfport, MS 39501

4500 13th St
Ste 300
Gulfport, MS 39501

9454 Three Rivers Rd
Gulfport, MS 39503

5120 Beatline Rd
#A
Long Beach, MS 39560
Phone (228) 868-4287

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ajm Oustalet Individual Corporate OfficerBoard Member Mar 1, 2009 5%
Peggy L Noonan Individual Corporate DirectorDirector, Business Services May 1, 2020 5%
W-2 Managing EmployeeDirector, Business Services Jan 1, 2006 5%
Kent Nicaud Individual Corporate DirectorChief Executive Officer Nov 1, 2008
W-2 Managing EmployeeCeo Nov 1, 2008
Thaddeus Carter Individual Corporate OfficerBoard Member Aug 1, 2017 5%
Claire Tindell Individual Corporate OfficerBoard Member Jan 1, 2019 5%
Harrison County Board of Supervisors Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Carrolyn Hamilton Individual Corporate Director Aug 10, 2009
David H White Individual Corporate Director Sep 17, 1993
City of Gulfport Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Jennifer Dumal Individual W-2 Managing Employee Feb 8, 1998
Carlos Bell Individual Corporate OfficerBoard Secretary Nov 26, 2018 5%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 765

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 765

NPI Registry JSON

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

{
    "created_epoch": "1264377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294012800000",
    "number": "1376874792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 555",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395330555",
            "telephone_number": "228-864-0854",
            "fax_number": "228-865-1457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1285 SPRING ST",
            "address_2": "SUITE A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073423",
            "telephone_number": "228-896-6441",
            "fax_number": "228-896-6576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-25",
        "last_updated": "2011-01-03",
        "status": "A",
        "authorized_official_last_name": "STEINER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "228-865-3106",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02874208",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIANS CLINIC AT MHG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.