Centerwell Senior Primary Care Ms CS PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CENTERWELL SENIOR PRIMARY CARE MS CS PC

Practice address

2650 Beach Blvd Ste 40
Biloxi, MS 39531-4517

Phone

(407) 447-7120

NPI assigned

Mar 20, 2025

Last updated

Apr 23, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angie Martinez

Title

Senior Credentialing Professional

Phone

(407) 447-7120

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly La'Tette Campbell, NP

  • Family Nurse Practitioner
  • Biloxi, MS
  • NPI 1770221640
  Medicare reassignment NPD
• Jorri Shonte Davis, FNP-C

  • Family Nurse Practitioner
  • Canton, MS
  • NPI 1942505706
  Medicare reassignment NPD
• Brandon Mizell, M.D.

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1649624693
  Medicare reassignment NPD
• Cyrena Nerissa Muffley, FNP

  • Family Nurse Practitioner
  • Biloxi, MS
  • NPI 1164983060
  Medicare reassignment NPD
• Courtney Baisden, FNP

  • Family Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1043808595

  MS

  Medicare reassignment NPD
• Ashanti Coleman, FNP

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1720535743

  MS

  Medicare reassignment NPD
• Jonathan Stewart Rouwhorst, M.D.

  • Family Medicine Physician
  • Grand Haven, MI
  • NPI 1508120122

  MS

  Medicare reassignment NPD
• Kathryn Weber Chrzanowski, PA

  • Surgical Physician Assistant
  • Houston, TX
  • NPI 1245326305

  MS

  Medicare reassignment
• Erica Lache' Savage-Jeter, M.D.

  • Family Medicine Physician
  • Spartanburg, SC
  • NPI 1275657694
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1730980434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "407-447-7120",
            "fax_number": "407-770-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 BEACH BLVD STE 40",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395314517",
            "telephone_number": "407-447-7120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "128 Plantation Way",
            "address_purpose": "LOCATION",
            "city": "Jonesville",
            "state": "SC",
            "postal_code": "293532833",
            "country_code": "US",
            "telephone_number": "407-447-7120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE MS CS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-20",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cedar Lake Medical Center, PA
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• Cedar Lake Pediatric Clinic PLLC
• Cedar Lake Pharmacy (Lee Pharmacy)
• Cedar Lake Pharmacy (Cedar Lake Pharmacy LLC.)
• Centerwell Senior Primary Care Ms PC (CenterWell Senior Primary Care-Biloxi)
• Aubri Challis
• Rickey L Chance, D.O.
• Jin Sup Chang, DMD
• Changing Tides Counseling of Biloxi

• Internal Medicine Physician in Biloxi, MS
• Providers in Biloxi, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.