Active NPI
Richard J Paddock, MD
- Urology Physician
- Gulfport, MS
National Provider Identifier
1679565428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 32690
- Practice address
- 1340 Broad Ave
Suite 210
Gulfport, MS 39501 - Phone
- (228) 575-1600
- Fax
- (228) 575-1603
- NPI assigned
- Aug 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 015310 | LA | |
| Urology Physician | 208800000X | 32690 | MS | Primary |
Addresses
Primary practice location
1340 Broad Ave
Suite 210
Gulfport, MS 39501
Mailing address
PO Box 1810
Gulfport, MS 39502
Phone (228) 575-1600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1335169 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240318003167 | MS | Practitioner - Urology | 0941331862 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Urology
- Education
- Tulane University School of Medicine, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Memorial Hospital at Gulfport
Practice addresses (Care Compare)
1340 Broad Ave
Gulfport, MS 39501-2460
1340 Broad Ave
Gulfport, MS 39501-2465
Hospital & facility affiliations
- Memorial Hospital at Gulfport
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32690 | MS | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients |
Locations
1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856
1340 Broad Ave
Ste 210
Gulfport, MS 39501
Phone (228) 575-1600
Interoperability endpoints
- rpaddock@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.
-
- General Acute Care Hospital
- Biloxi, MS
- NPI 1215546635
-
- Family Medicine Physician
- Biloxi, MS
- NPI 1609203173
-
- Emergency Medicine Physician
- Gulfport, MS
- NPI 1962780379
Hospital & facility affiliations 60
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Gulfport, MS
- NPI 1184956815
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707955200000",
"number": "1679565428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1810",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39502",
"telephone_number": "228-575-1600",
"fax_number": "228-575-2917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1340 BROAD AVE",
"address_2": "SUITE 210",
"city": "GULFPORT",
"state": "MS",
"postal_code": "39501",
"telephone_number": "228-575-1600",
"fax_number": "228-575-1603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PADDOCK",
"first_name": "RICHARD",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-18",
"last_updated": "2024-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "LA",
"license": "015310",
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MS",
"license": "32690",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1335169",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}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 Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.