NPIMap

Individual provider Active NPI

Jacinta Stegall

  • Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1699127027
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
901497 Issued in MS
Practice address
848 S Madison St
Tupelo, MS 38801-4905
Phone
(662) 844-4177
NPI assigned
Jul 9, 2016
Last updated
Apr 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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 901497 MS Primary

Addresses

Primary practice location

848 S Madison St
Tupelo, MS 38801-4905

Mailing address

4215 15TH St
Gulfport, MS 39501-2523
Phone (228) 863-5211

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
I20160908000545 MS Practitioner - Nurse Practitioner 3971899576 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

9000 Lorraine Rd
Suite a
Gulfport, MS 39503-6101
Phone (228) 864-2121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
901497MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Nurse Practitioner CurrentSince Apr 19, 2021 Accepting new patients
Southern Medical Consultants LLC CurrentSince Jul 1, 2019 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Gulf Coast Ear Nose and Throat Associates, LLC CurrentSince Dec 2, 2024 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Apr 19, 2021 Accepting new patients
Midnight-Medical, Inc. Family PastSince Apr 20, 2009 Accepting new patients

Locations

108 Four LN Hwy 49
Bentonia, MS 39040
Phone (662) 998-8900

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

4215 15th St
Gulfport, MS 39501
Phone (228) 863-5211

9000 Lorraine Rd
Gulfport, MS 39503
Phone (228) 864-2121

9000 Lorraine Rd
Ste C
Gulfport, MS 39503
Phone (228) 864-2121

Interoperability endpoints

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

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1468022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1699127027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 15TH ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012523",
            "telephone_number": "228-863-5211",
            "fax_number": "228-863-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "848 S MADISON ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014905",
            "telephone_number": "662-844-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEGALL",
        "first_name": "JACINTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-09",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "901497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.