NPIMap

Individual provider Active NPI

Candace Noel Pendowski, ACNP

  • Nurse Practitioner
  • Pascagoula, MS
National Provider Identifier
1487919957
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R872680 Issued in MS
Practice address
4211 Hospital St Suite 208
Pascagoula, MS 39581
Phone
(228) 762-5982
Fax
(228) 769-7698
NPI assigned
Jul 10, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R872680 MS Primary

Addresses

Primary practice location

4211 Hospital St Suite 208
Pascagoula, MS 39581

Mailing address

4211 Hospital Street Suite 208
Pascagoula, MS 39581
Phone (228) 762-5982

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
I20120813000472 MS Practitioner - Nurse Practitioner 8123274826 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-5201

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Jun 26, 2017 Accepting new patients
Memorial Hospital at Gulfport Nurse Practitioner CurrentSince Jun 26, 2017 Accepting new patients
Singing River Health System Nurse Practitioner CurrentSince Oct 9, 2017 Accepting new patients

Locations

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

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

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

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

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1341878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1487919957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 HOSPITAL STREET SUITE 208",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "39581",
            "telephone_number": "228-762-5982",
            "fax_number": "228-769-7698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 HOSPITAL ST SUITE 208",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "39581",
            "telephone_number": "228-762-5982",
            "fax_number": "228-769-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDOWSKI",
        "first_name": "CANDACE",
        "middle_name": "NOEL",
        "credential": "ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-10",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R872680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

Verify at the official NPI Registry.