NPIMap

Individual provider Active NPI

Rod G Krentel, M.D.

  • Radiation Oncology Physician
  • Gulfport, MS
National Provider Identifier
1629060041
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
16116 Issued in MS
Practice address
1340 Broad Ave Ste 140
Gulfport, MS 39501
Phone
(228) 575-2950
NPI assigned
Aug 22, 2005
Last updated
Sep 5, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 00019798 AL
Radiation Oncology Physician 2085R0001X 16116 MS Primary

Addresses

Primary practice location

1340 Broad Ave Ste 140
Gulfport, MS 39501

Mailing address

1340 Broad Ave Ste 140
Gulfport, MS 39501-2445
Phone (228) 575-2950

Other practice location 1

1545 Airport Blvd
Suite 1000
Pensacola, FL 32504-8615
Phone (850) 474-8744

Other identifiers 1

IdentifierTypeStateIssuer
000033662MedicaidAL

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
I20150706002202 MS Practitioner - Radiation Oncology 4284728445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Louisiana State University School of Medicine in New Orleans, 1992
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)

1340 Broad Ave
Suite 140
Gulfport, MS 39501-2445
Phone (228) 575-2950

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
00019798ALMDSpecialist
19798ALMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
West Florida Medical Center Clinic PA Past Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
Biloxi Radiation Oncology Center LLC Radiation Oncology Past Accepting new patients
Emerald Coast Radiation Oncology Radiation Oncology Past Accepting new patients

Locations

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

Interoperability endpoints

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

Organizations & group practices 6

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 63

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1629060041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE STE 140",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012445",
            "telephone_number": "228-575-2950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE STE 140",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39501",
            "telephone_number": "228-575-2950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1545 Airport Blvd",
            "address_2": "SUITE 1000",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325048615",
            "country_code": "US",
            "telephone_number": "850-474-8744",
            "fax_number": "850-416-7770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRENTEL",
        "first_name": "ROD",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "00019798",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MS",
            "license": "16116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000033662",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.