NPIMap

Individual provider Active NPI

Melantha Dorthea Manns, M.D.

  • Internal Medicine Physician
  • Gulfport, MS
National Provider Identifier
1750615076
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20915 Issued in MS
Practice address
4500 13TH Street
Gulfport, MS 39501
Phone
(228) 867-4396
Fax
(228) 867-5354
NPI assigned
Sep 21, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 20915 MS
Internal Medicine Physician 207R00000X 20915 MS Primary

Addresses

Primary practice location

4500 13TH Street
Gulfport, MS 39501

Mailing address

PO Box 1810
Gulfport, MS 39502
Phone (228) 575-1194

Other identifiers 1

IdentifierTypeStateIssuer
03442094MedicaidMS

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
I20101109001153 MS Practitioner - Emergency MedicinePractitioner - Internal Medicine 7113112756 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
Meharry Medical College School of Medicine, 2006
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

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20915MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Keystone Medical Services of Ms, Inc CurrentSince Jul 1, 2016 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Dec 1, 2014 Accepting new patients
Memorial Hospital at Gulfport Internal Medicine CurrentSince Dec 1, 2014 Accepting new patients

Locations

701 S Holly Ave
Collins, MS 39428
Phone (601) 765-3180

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

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

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

100 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-0455

Interoperability endpoints

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

Organizations & group practices 5

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.

Hospital & facility affiliations 61

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1750615076",
    "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": "228-575-1194",
            "fax_number": "228-575-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 13TH STREET",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39501",
            "telephone_number": "228-867-4396",
            "fax_number": "228-867-5354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNS",
        "first_name": "MELANTHA",
        "middle_name": "DORTHEA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-21",
        "last_updated": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MS",
            "license": "20915",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "20915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03442094",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.