NPIMap

Organization Active NPI

Memorial Hospital at Gulfport

Doing business as Memorial Woodland Village Nursing Center

  • Skilled Nursing Facility
  • Diamondhead, MS
National Provider Identifier
1619066248
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
692 Issued in MS
Legal business name
MEMORIAL HOSPITAL AT GULFPORT
Doing business as
Memorial Woodland Village Nursing Center
Practice address
5427 Gex Rd
Diamondhead, MS 39525-3208
Phone
(228) 255-4832
Fax
(228) 255-4833
NPI assigned
Oct 12, 2006
Last updated
Jan 9, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HOSPITAL AT GULFPORTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

Name
Peggy Lorraine Noonan, BS, CPC
Title
Physician Business Services Dir.
Phone
(228) 575-1740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 692 MS Primary

Addresses

Primary practice location

5427 Gex Rd
Diamondhead, MS 39525-3208

Mailing address

5427 Gex Rd
Diamondhead, MS 39525-3208
Phone (228) 255-4832

Other identifiers 1

IdentifierTypeStateIssuer
00230023MedicaidMS

Other names 1

  • Memorial Woodland Village Nursing Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191029000487 MS Part A Provider - Skilled Nursing Facility 9537062997 Practice locations: Diamonhead, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619066248. Details of each certification follow.

Skilled nursing facility certification: CCN 255163

Legal name
MEMORIAL HOSPITAL AT GULFPORT
Doing business as
MEMORIAL WOODLAND VILLAGE NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Mar 15, 1993
Last certification
Feb 29, 2024
Beds
132
Ownership / control type
Individual
Organization structure
OtherNon-profit
Enrollment address
5427 Gex Road
Diamonhead, MS 39525-3208
Nursing home name
MEMORIAL WOODLAND VILLAGE NURSING CENTER

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Memorial Woodland Village Nursing CenterCCN 255163 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Mar 15, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
13299.8 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0891924Memorial Woodland Village Nursing Center5427 Gex Road, Diamondhead, MS 39525Certificate of waiverSep 20, 2026

National Provider Directory

National Provider Directory
Part of
Memorial Hospital

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Myron McCoo Individual Corporate OfficerVP Human Resources Sep 22, 2019 5%
W-2 Managing EmployeeVP Human Resources Sep 22, 2019 5%
Operational/Managerial ControlVP Human Resources Sep 22, 2019 5%
Corporate Management, Inc. Organization, Gulfport, MS Corporation Operational/Managerial Control Sep 22, 2019 90%
Peggy L Noonan Individual Corporate DirectorDirector, Business Services and Med Apr 1, 2020 5%
Kent Nicaud Individual Corporate OfficerChief Executive Officer Sep 22, 2019 100%
W-2 Managing EmployeeChief Executive Officer Sep 22, 2019 100%
Operational/Managerial ControlChief Executive Officer Sep 22, 2019 100%
Haley Zelenka Individual Corporate OfficerVP General Counsel Sep 22, 2019 5%
W-2 Managing EmployeeVP General Counsel Sep 22, 2019 5%
Operational/Managerial ControlVP General Counsel Sep 22, 2019 5%
Harrison County Board of Supervisors Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Sep 22, 2019 50%
City of Gulfport Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Sep 22, 2019 50%
Jennifer Dumal Individual Corporate OfficerChief Nursing Officer Sep 22, 2019 5%
W-2 Managing EmployeeChief Nursing Officer Sep 22, 2019 5%
Operational/Managerial ControlChief Nursing Officer Sep 22, 2019 5%
Eugene Thomas Individual Contracted Managing EmployeeChief Information Officer Sep 22, 2019 5%
Corporate OfficerChief Information Officer Sep 22, 2019 5%
Operational/Managerial ControlChief Information Officer Sep 22, 2019 5%
Joshua L Bryan Individual W-2 Managing EmployeeNursing Home Administrator Sep 22, 2019 5%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Hospital BiloxiBiloxi, MS, CCN 250175 Hospital 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Biloxi Hma LLC

    dba Memorial Hospital Biloxi

    • General Acute Care Hospital
    • Biloxi, MS
    • NPI 1972557064

    5% Or Greater Indirect Ownership Interest

    CMS ownership

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1619066248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5427 GEX RD",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253208",
            "telephone_number": "228-255-4832",
            "fax_number": "228-255-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5427 GEX RD",
            "city": "DIAMONDHEAD",
            "state": "MS",
            "postal_code": "395253208",
            "telephone_number": "228-255-4832",
            "fax_number": "228-255-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "enumeration_date": "2006-10-12",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "NOONAN",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "LORRAINE",
        "authorized_official_title_or_position": "PHYSICIAN BUSINESS SERVICES DIR.",
        "authorized_official_telephone_number": "228-575-1740",
        "authorized_official_credential": "BS, CPC"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00230023",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Memorial Woodland Village Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Diamondhead, MS

Sources for this page

Verify at the official NPI Registry.