Ochsner Mississippi, LLC
Organization Active NPI Internal Medicine Physician · Gulfport, MS
NPI 1639766132 · NPPES record last updated Dec 30, 2020
Key facts
- NPI
- 1639766132
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- OCHSNER MISSISSIPPI, LLC
- Practice address
- 4502 Old Pass Rd
Gulfport, MS 39501-2585 - Phone
- (228) 863-9977
- Fax
- (228) 863-9912
- NPI assigned
- Dec 30, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- OCHSNER MISSISSIPPI, LLC
Authorized official
- Name
- Eduardo Benitez
- Title
- Director
- Phone
- (504) 430-0025
Other NPIs on the same Medicare enrollment 17
Corporate family (same tax ID) 24
Practitioners 7
-
Erin Quave, RD
-
Andrea A. Birch, MD
-
Barbara Kate Neuhoff, M.D.
-
Angelina M. Stratton, RDN, LDN, CDCES
-
Aqib Sultan, MD
-
Alec Weir, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180216000366 | MS | Part B Supplier - Clinic/Group Practice | 0143580993 |
Receives reassigned benefits from 325 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bay Saint Louis, MS; Picayune, MS; McComb, MS; Madison, MS; Hattiesburg, MS; Gulfport, MS; Flowood, MS; Diamondhead, MS… |
National Provider Directory
- Tax ID family
- Ochsner Mississippi LLC
- Part of
- Ochsner Mississippi LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
4502 Old Pass Rd
Gulfport, MS 39501-2585
Mailing address
1514 Jefferson Hwy
New Orleans, LA 70121-2429
Phone (504) 842-4000
Other names
- Ochsner Health Center - Downtown
Other providers in Gulfport, MS
- Ocean Blue Therapy Group PLLC
- Ochsner Clinic LLC
- Ochsner Clinic LLC
- Ochsner Mississippi, LLC
- Ochsner Mississippi, LLC
- Ochsner Mississippi, LLC
- Rebecca Rose Ogilvie
- Emmanuel Ogunleye
- Michael Somto Okoene
- Jason Franklin Olaivar
All providers in Gulfport, MS · Internal 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 Dec 30, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.