Ochsner Mississippi, LLC
Organization Active NPI Internal Medicine Physician · Gulfport, MS
NPI 1386230910 · NPPES record last updated Dec 17, 2020
Key facts
- NPI
- 1386230910
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- OCHSNER MISSISSIPPI, LLC
- Practice address
- 1924 E Pass Rd
Gulfport, MS 39507-3715 - Phone
- (228) 388-4862
- Fax
- (228) 388-2556
- NPI assigned
- Dec 17, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- OCHSNER MISSISSIPPI, LLC
Authorized official
- Name
- Eduardo Benitez
- Title
- Director
- Phone
- (504) 430-0025
Other NPIs on the same Medicare enrollment 17
Corporate family (same tax ID) 24
Practitioners 7
-
Brian Raymond Pitre, M.D.
-
Ali Alian, M.D.
-
Karee Balfantz, LDN, RDN
-
Orn-USA Boonprakong, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180216000366 | MS | Part B Supplier - Clinic/Group Practice | 0143580993 |
Receives reassigned benefits from 325 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bay Saint Louis, MS; Picayune, MS; McComb, MS; Madison, MS; Hattiesburg, MS; Gulfport, MS; Flowood, MS; Diamondhead, MS… |
National Provider Directory
- Tax ID family
- Ochsner Mississippi LLC
- Part of
- Ochsner Mississippi LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1924 E Pass Rd
Gulfport, MS 39507-3715
Mailing address
1514 Jefferson Hwy
New Orleans, LA 70121-2429
Phone (504) 842-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09627255 | Medicaid | MS |
Other names
- Ochsner Health Center - East Pass Rd
Other providers in Gulfport, MS
- Obtelecare Mississippi, PC
- Ocean Blue Therapy Group PLLC
- Ochsner Clinic LLC
- Ochsner Clinic LLC
- Ochsner Mississippi, LLC
- Ochsner Mississippi, LLC
- Ochsner Mississippi, LLC
- Rebecca Rose Ogilvie
- Emmanuel Ogunleye
- Michael Somto Okoene
All providers in Gulfport, MS · Internal Medicine 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 Dec 17, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.