NPIMap

Individual provider Active NPI

Elizabeth Ann Seal, NP-C

  • Family Nurse Practitioner
  • Bay St Louis, MS
National Provider Identifier
1649688912
Registry record updated Aug 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R882671 Issued in MS
Practice address
725 Dunbar Ave
Bay St Louis, MS 39520-2920
Phone
(228) 466-3099
Fax
(228) 867-5048
NPI assigned
Jul 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Registered Nurse 163WG0100X R882671 MS
Family Nurse Practitioner 363LF0000X R882671 MS Primary

Addresses

Primary practice location

725 Dunbar Ave
Bay St Louis, MS 39520-2920

Mailing address

6100 Old Brandon Rd
Brandon, MS 39042-2543
Phone (228) 867-5057

Other names 1

  • Miss Elizabeth Ann Stafford Former name

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
I20150325001722 MS Practitioner - Nurse Practitioner 9830416114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Exceed Physical Therapy, LLCGroup PAC ID 8123378338, 72 clinicians

Practice addresses (Care Compare)

12261 Hwy 49
Suite 1
Gulfport, MS 39503-2976
Phone (228) 265-7185

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R882671MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sentry Rehab, LLC Current Accepting new patients
Sentry Rehab, LLC CurrentSince Apr 12, 2018 Accepting new patients
Professional Rehabilitation Hospital LLC Past Accepting new patients

Locations

725 Dunbar Ave
Bay St Louis, MS 39520
Phone (228) 446-3099

106A Office Park Dr
Brandon, MS 39042
Phone (601) 824-9010

Interoperability endpoints

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

Organizations & group practices 4

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 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": "1406678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1649688912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 OLD BRANDON RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422543",
            "telephone_number": "228-867-5057",
            "fax_number": "228-867-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 DUNBAR AVE",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395202920",
            "telephone_number": "228-466-3099",
            "fax_number": "228-867-5048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEAL",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-30",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gastroenterology",
            "state": "MS",
            "license": "R882671",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R882671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "STAFFORD",
            "middle_name": "ANN",
            "prefix": "MISS",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bay St Louis, MS

Sources for this page

Verify at the official NPI Registry.