NPIMap

Individual provider Active NPI

Brian Clayton Gibson, CNP

  • Acute Care Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1427337765
Registry record updated Jan 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R872628 Issued in MS
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 268-5800
Fax
(601) 261-3530
NPI assigned
Aug 4, 2011
Last updated
Jan 30, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2015

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 R872628 MS Primary
Family Nurse Practitioner 363LF0000X R872628 MS

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 579-5463

Other identifiers 3

IdentifierTypeStateIssuer
P01013953OtherMSRAILROAD MEDICARE
9695764OtherMSAETNA
09853301MedicaidMS

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
I20110921000376 MS Practitioner - Nurse Practitioner 8224209390 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Services of the Gulf Coast LLCGroup PAC ID 8426301607, 32 clinicians
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1018 Cowan Rd
Gulfport, MS 39507-3404
Phone (228) 265-7945

1391 Broad Ave
Suite a
Gulfport, MS 39501-2419
Phone (228) 863-8868

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R872628MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Room Group LTD CurrentSince May 9, 2023 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Jun 17, 2024 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Cooper Family Medical Center Inc. CurrentSince Oct 1, 2024 Accepting new patients
Physician Services of the Gulf Coast LLC CurrentSince Oct 1, 2024 Accepting new patients
Community Care Health Network LLC CurrentSince Jan 1, 2024 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

1756 Popps Ferry Rd
Ste A
Biloxi, MS 39532
Phone (228) 865-3200

921 Cedar Lake Rd
Ste E
Biloxi, MS 39532
Phone (228) 396-3945

1018 Cowan Rd
Gulfport, MS 39507
Phone (228) 265-7945

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

1391 Broad Ave
Ste A
Gulfport, MS 39501
Phone (228) 669-6328

6652 U S Highway 98
Hattiesburg, MS 39402

232 Market St
Jackson, MS 39232
Phone (588) 498-6767

1113 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 300-5945

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

8288 Firetower Rd
Ste F
Pass Christian, MS 39571
Phone (228) 222-8900

Interoperability endpoints

  • Direct secure messaging: brian.gibson.1@24353.direct.athenahealth.com

Organizations & group practices 8

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 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422576000000",
    "number": "1427337765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-579-5463",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-268-5800",
            "fax_number": "601-261-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "BRIAN",
        "middle_name": "CLAYTON",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2015-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R872628",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R872628",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01013953",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9695764",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09853301",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.