NPIMap

Individual provider Active NPI

Tiffany Brosh, N.P.

  • Family Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1518404235
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
901909 Issued in MS
Practice address
4215 15TH St
Gulfport, MS 39501-2523
Phone
(228) 863-5211
Fax
(228) 863-4101
NPI assigned
Jan 20, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 901909 MS Primary

Addresses

Primary practice location

4215 15TH St
Gulfport, MS 39501-2523

Mailing address

4215 15TH Street
Gulfport, MS 39501
Phone (228) 863-5211

Other practice location 1

13913 Deneen Rd
Ocean Springs, MS 39565-9599
Phone (228) 860-3896

Other identifiers 1

IdentifierTypeStateIssuer
05859035MedicaidMS

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
I20170424000402 MS Practitioner - Nurse Practitioner 6901182112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

4215 15TH St
Gulfport, MS 39501-2523
Phone (228) 863-5211

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
901909MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport CurrentSince Mar 27, 2017 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients

Locations

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

4215 15th St
Gulfport, MS 39501
Phone (228) 863-5211

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

Interoperability endpoints

  • Direct secure messaging: tbrosh1@direct.mhg.com

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 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": "1484870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1518404235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 15TH STREET",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39501",
            "telephone_number": "228-863-5211",
            "fax_number": "228-863-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 15TH ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012523",
            "telephone_number": "228-863-5211",
            "fax_number": "228-863-4101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13913 Deneen Rd",
            "address_purpose": "LOCATION",
            "city": "Ocean Springs",
            "state": "MS",
            "postal_code": "395659599",
            "country_code": "US",
            "telephone_number": "228-860-3896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROSH",
        "first_name": "TIFFANY",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "901909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05859035",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.