NPIMap

Individual provider Active NPI

Stephanie M Damitio, C.R.N.A

  • Certified Registered Nurse Anesthetist
  • Gulfport, MS
National Provider Identifier
1447585435
Registry record updated Nov 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R876698 Issued in MS
Practice address
15190 Community Rd Ste 230a
Gulfport, MS 39503-3483
Phone
(228) 831-0204
Fax
(228) 831-1868
NPI assigned
Oct 8, 2009
Last updated
Nov 4, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R876698 MS Primary

Addresses

Primary practice location

15190 Community Rd Ste 230a
Gulfport, MS 39503-3483

Mailing address

15190 Community Rd Ste 230a
Gulfport, MS 39503-3483
Phone (228) 831-0204

Other identifiers 1

IdentifierTypeStateIssuer
R877698OtherMSLICENSE NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100208000685 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 8729121058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Louisiana State University School of Medicine in New Orleans, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Anesthesia Service PAGroup PAC ID 2062849763, 6 clinicians

Practice addresses (Care Compare)

3017 13TH St
Gulfport, MS 39501-1833
Phone (228) 831-0050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
R876698MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Anesthesia Service PA CurrentSince Apr 1, 2020 Accepting new patients
Gulfport Outpatient Anesthesia, P.a. Past Accepting new patients
Joycelyn M. Theard M.D,P.a. Past Accepting new patients

Locations

3017 13th St
Gulfport, MS 39501
Phone (228) 831-0050

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 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": "1254960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257292800000",
    "number": "1447585435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD STE 230A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033483",
            "telephone_number": "228-831-0204",
            "fax_number": "228-831-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD STE 230A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033483",
            "telephone_number": "228-831-0204",
            "fax_number": "228-831-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMITIO",
        "first_name": "STEPHANIE",
        "middle_name": "M",
        "credential": "C.R.N.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-08",
        "last_updated": "2009-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R876698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "R877698",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.