Martin Bydalek, M.D.
Individual provider Active NPI Family Medicine Physician · Pascagoula, MS
NPI 1609926211 · NPPES record last updated Feb 11, 2016
Key facts
- NPI
- 1609926211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 10633 (MS)
- Practice address
- 2819 Denny Ave
Pascagoula, MS 39581 - Phone
- (228) 762-3466
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091015000177 | MS | Practitioner - Family Practice |
7618013111 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MS10633 | MS | MD | Emergency Medicine Physician |
| 10633 | MS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Singing River Health System | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Emergency Medicine | Past | Accepting new patients |
| Anchor Medical Clinic PLLC | Emergency Medicine | Past |
Accepting new patients |
Locations
2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576
3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100
3101 Denny Ave
#200
Pascagoula, MS 39581
Phone (228) 471-1476
2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000
2819 Denny Ave
Pascagoula, MS 39581
Phone (228) 762-3466
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10633 | MS | Yes |
| Emergency Medicine Physician | 207P00000X | MS10633 | MS |
Addresses
Primary practice location
2819 Denny Ave
Pascagoula, MS 39581
Mailing address
2819 Denny Avenue
Pascagoula, MS 39581
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 930026514 | Other | RAILROAD MEDICARE | |
| 00015597 | Medicaid | MS | |
| 386693YKC0 | Other | MS | MEDICARE |
| 646000515 | Other | TRICARE | |
| 008605220 | Medicaid | AL | |
| 646000515 | Other | BLUE CROSS OF MS |
Other providers in Pascagoula, MS
- Julie Bullock
- Lindsay Williams Buono
- Valerie B Buras
- Donna Marie Burks
- Robert Benjamin Burns
- Marianne Cabrera-Arroyo
- Victor Calcote
- Venus Jeanette Callahan
- Cynthia Jean Camburn
- Ambrose Campbell
All providers in Pascagoula, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.