NPIMap

Individual provider Active NPI

Amy Vanderbeck Rogers, ACNP-BC

  • Acute Care Nurse Practitioner
  • Pascagoula, MS
National Provider Identifier
1417249053
Registry record updated Oct 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
888068 Issued in MS
Practice address
2809 Denny Ave
Pascagoula, MS 39581-5301
Phone
(228) 809-5510
NPI assigned
May 13, 2011
Last updated
Oct 13, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1-107630 AL
Acute Care Nurse Practitioner 363LA2100X 888068 MS Primary

Addresses

Primary practice location

2809 Denny Ave
Pascagoula, MS 39581-5301

Mailing address

2101 Highway 90
Gautier, MS 39553-5340
Phone (228) 497-7576

Other identifiers 1

IdentifierTypeStateIssuer
03930778MedicaidMS

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
I20110914000393 MS Practitioner - Nurse Practitioner 5799956249 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

2809 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 818-0563

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System CurrentSince Aug 8, 2011 Accepting new patients
Singing River Health System CurrentSince Aug 8, 2011 Accepting new patients
Singing River Gulfport CurrentSince Jun 2, 2024 Accepting new patients

Locations

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

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

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

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

Organizations & group practices 3

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.

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": "1305244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507852800000",
    "number": "1417249053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535340",
            "telephone_number": "228-497-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815301",
            "telephone_number": "228-809-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "AMY",
        "middle_name": "VANDERBECK",
        "credential": "ACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-13",
        "last_updated": "2017-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-107630",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "888068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03930778",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

Verify at the official NPI Registry.