NPIMap

Organization Active NPI

Memorial Hospital at Gulfport

  • Internal Medicine Physician
  • Gulfport, MS
National Provider Identifier
1740617232
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEMORIAL HOSPITAL AT GULFPORT
Practice address
1340 Broad Ave Ste 310
Gulfport, MS 39501-2464
Phone
(228) 575-1400
Fax
(228) 575-1414
NPI assigned
Sep 30, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Peggy Lorraine Noonan, BS, CPC
Title
Physician Business Services Dir.
Phone
(228) 575-1740

Corporate family (same tax ID) 20

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 42

Affiliated clinicians 765

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 765

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial Hospital at GulfportCCN 250019
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Hospital certification: CCN 250019

Medicare enrollment files
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
OtherNon-profit
Enrollment address
4500 13TH St
Gulfport, MS 39501-2515
Hospital subgroups
Acute care

All disclosed owners & managing parties 11

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ajm Oustalet Individual Corporate OfficerBoard Member Mar 1, 2009 5%
Peggy L Noonan Individual Corporate DirectorDirector, Business Services May 1, 2020 5%
W-2 Managing EmployeeDirector, Business Services Jan 1, 2006 5%
Kent Nicaud Individual Corporate DirectorChief Executive Officer Nov 1, 2008
W-2 Managing EmployeeCeo Nov 1, 2008
Thaddeus Carter Individual Corporate OfficerBoard Member Aug 1, 2017 5%
Claire Tindell Individual Corporate OfficerBoard Member Jan 1, 2019 5%
Harrison County Board of Supervisors Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Carrolyn Hamilton Individual Corporate Director Aug 10, 2009
David H White Individual Corporate Director Sep 17, 1993
City of Gulfport Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Jennifer Dumal Individual W-2 Managing Employee Feb 8, 1998
Carlos Bell Individual Corporate OfficerBoard Secretary Nov 26, 2018 5%

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20080515000774 MS Part a Provider - Hospital 9537062997 This NPI is an additional NPI on the enrollment
O20090515000396 MS Part B Supplier - Clinic/Group Practice 2466524012 Receives reassigned benefits from 753 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosp ER Dept (21 organizations share this tax ID)

Locations

4577 13th St
Gulfport, MS 39501
Phone (228) 864-2752

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

NPPES NPI Registry

Primary practice location

1340 Broad Ave Ste 310
Gulfport, MS 39501-2464

Mailing address

PO Box 1810
Gulfport, MS 39502-1810
Phone (228) 575-1700

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 9, 2024.

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1740617232",
    "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": "395021810",
            "telephone_number": "228-575-1700",
            "fax_number": "228-575-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE STE 310",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012464",
            "telephone_number": "228-575-1400",
            "fax_number": "228-575-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-30",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "NOONAN",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "LORRAINE",
        "authorized_official_title_or_position": "PHYSICIAN BUSINESS SERVICES DIR.",
        "authorized_official_telephone_number": "228-575-1740",
        "authorized_official_credential": "BS, CPC"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.