NPIMap

Organization Active NPI

TBD Acquisition II LLC

  • Psychiatry Physician
  • Gulfport, MS
National Provider Identifier
1780191577
Registry record updated Jan 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
TBD ACQUISITION II LLC
Practice address
1340 Broad Ave
Gulfport, MS 39501-2404
Phone
(228) 867-5202
NPI assigned
Jan 3, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2018

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

Authorized official

Name
Steve Filton
Title
Cfo Sr VP
Phone
(610) 768-3482

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1340 Broad Ave
Gulfport, MS 39501-2404

Mailing address

11150 Highway 49
Gulfport, MS 39503-4110
Phone (228) 867-5202

Other names 1

  • Gulfport Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171219001761 MS Part B Supplier - Clinic/Group Practice 7911272257 Receives reassigned benefits from 50 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gulfport, MS

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514937600000",
    "number": "1780191577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11150 HIGHWAY 49",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034110",
            "telephone_number": "228-867-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012404",
            "telephone_number": "228-867-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TBD ACQUISITION II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2018-01-03",
        "status": "A",
        "authorized_official_last_name": "FILTON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CFO SR VP",
        "authorized_official_telephone_number": "610-768-3482"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulfport Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 3, 2018; 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.