Active NPI
Memorial Hospital of Gulfport
- Urology Physician
- Gulfport, MS
National Provider Identifier
1669619912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- MEMORIAL HOSPITAL OF GULFPORT
- Practice address
- 1340 Broad Ave
Ste 210
Gulfport, MS 39501-2404 - Phone
- (228) 575-1600
- Fax
- (228) 575-1603
- NPI assigned
- Jan 8, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jeff T Steiner
- Title
- VP of Finance
- Phone
- (228) 865-3106
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | Primary |
Addresses
Primary practice location
1340 Broad Ave
Ste 210
Gulfport, MS 39501-2404
Mailing address
PO Box 555
Biloxi, MS 39533-0555
Phone (228) 865-1453
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06471328 | Medicaid | MS |
Other names 1
- Physicians Clinic at MHG
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080515000774 | MS | Part A Provider - Hospital | 9537062997 | This NPI is an additional NPI on the enrollment |
Hospital certification: CCN 250019
- Legal name
- MEMORIAL HOSPITAL AT GULFPORT
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Aug 19, 2009
- Beds
- 445
- Ownership / control type
- Local
- Organization structure
- Other
- Enrollment address
- 4500 13TH St
Gulfport, MS 39501-2515 - Hospital subgroups
- Acute care
Care Compare: Hospital
Medicare Care Compare- Listed as
- Memorial Hospital at Gulfport
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider DirectoryLocations
1340 Broad Ave
Ste 210
Gulfport, MS 39501
Phone (228) 575-1600
Ownership & related parties
All disclosed owners & managing parties 11
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Ajm Oustalet | Corporate Officer | Mar 1, 2009 | 5% |
| Peggy L Noonan | Corporate Director | May 1, 2020 | 5% |
| W-2 Managing Employee | Jan 1, 2006 | 5% | |
| Kent Nicaud | Corporate Director | Nov 1, 2008 | |
| W-2 Managing Employee | Nov 1, 2008 | ||
| Thaddeus Carter | Corporate Officer | Aug 1, 2017 | 5% |
| Claire Tindell | Corporate Officer | Jan 1, 2019 | 5% |
| Harrison County Board of Supervisors | 5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Carrolyn Hamilton | Corporate Director | Aug 10, 2009 | |
| David H White | Corporate Director | Sep 17, 1993 | |
| City of Gulfport | 5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Jennifer Dumal | W-2 Managing Employee | Feb 8, 1998 | |
| Carlos Bell | Corporate Officer | Nov 26, 2018 | 5% |
Practitioners & affiliated clinicians
Affiliated clinicians 765
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": "1231372800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1294012800000",
"number": "1669619912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 555",
"city": "BILOXI",
"state": "MS",
"postal_code": "395330555",
"telephone_number": "228-865-1453",
"fax_number": "228-865-1457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1340 BROAD AVE",
"address_2": "STE 210",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395012404",
"telephone_number": "228-575-1600",
"fax_number": "228-575-1603"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEMORIAL HOSPITAL OF GULFPORT",
"organizational_subpart": "NO",
"enumeration_date": "2009-01-08",
"last_updated": "2011-01-03",
"status": "A",
"authorized_official_last_name": "STEINER",
"authorized_official_first_name": "JEFF",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "VP OF FINANCE",
"authorized_official_telephone_number": "228-865-3106",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06471328",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Physicians Clinic at MHG",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.