NPIMap

Individual provider Active NPI

Matt K Gatlin

  • Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1629634506
Registry record updated May 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
903251 Issued in MS
Practice address
1340 Broad Ave Ste 300
Gulfport, MS 39501-2404
Phone
(228) 575-2700
Fax
(228) 575-2710
NPI assigned
May 15, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2019

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 903251 MS Primary

Addresses

Primary practice location

1340 Broad Ave Ste 300
Gulfport, MS 39501-2404

Mailing address

1340 Broad Ave Ste 300
Gulfport, MS 39501-2404
Phone (228) 575-2700

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
I20190731003806 MS Practitioner - Nurse Practitioner 0143556910 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians
Gulf Coast Consultants Infectious Diseases LLCGroup PAC ID 3375921893, 4 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Suite 300B
Gulfport, MS 39501-2404
Phone (228) 575-2700

1500 Broad Ave
Gulfport, MS 39501-3601
Phone (228) 236-4262

1530 Broad Ave
Gulfport, MS 39501-3601
Phone (228) 236-4262

2572 Brighton Cir
Biloxi, MS 39531-2733

Hospital & facility affiliations

  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019
  • Memorial Hospital Biloxi Hospital, Biloxi, MS, CCN 250007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Consultants, Infectious Diseases, LLC CurrentSince Jun 15, 2022 Accepting new patients
Memorial Hospital at Gulfport CurrentSince May 13, 2019 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

147 Reynoir St
Ste 204
Biloxi, MS 39530
Phone (228) 374-6296

4500 13th St
Fl 3
Gulfport, MS 39501
Phone (228) 236-4262

1340 Broad Ave
Ste 300B
Gulfport, MS 39501
Phone (228) 575-2700

1340 Broad Ave
Ste 300
Gulfport, MS 39501
Phone (228) 575-2700

1340 Broad Ave
Ste 410
Gulfport, MS 39501
Phone (228) 575-1775

4500 13th St
Ste 900
Gulfport, MS 39501
Phone (228) 236-3872

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

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": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557878400000",
    "number": "1629634506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE STE 300",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012404",
            "telephone_number": "228-575-2700",
            "fax_number": "228-575-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE STE 300",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012404",
            "telephone_number": "228-575-2700",
            "fax_number": "228-575-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATLIN",
        "first_name": "MATT",
        "middle_name": "K",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-15",
        "last_updated": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "903251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.