NPIMap

Individual provider Active NPI

John Ryan Logan, MD

  • Internal Medicine Physician
  • Gautier, MS
National Provider Identifier
1801059381
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21375 Issued in MS
Practice address
2101 Highway 90
Gautier, MS 39553-5340
Phone
(228) 809-5510
Fax
(228) 809-5519
NPI assigned
Jul 6, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21375 MS Primary

Addresses

Primary practice location

2101 Highway 90
Gautier, MS 39553-5340

Mailing address

1812 Shelby LN
Ocean Springs, MS 39564-5055
Phone (601) 624-8229

Other identifiers 1

IdentifierTypeStateIssuer
21375OtherMSMS STATE BOARD OF MEDICAL LICENSURE

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
I20110726000641 MS Practitioner - Internal Medicine 5597933176 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21375MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System CurrentSince Jul 10, 2011 Accepting new patients
TBD Acquisition II LLC CurrentSince Feb 20, 2024 Accepting new patients
Singing River Gulfport CurrentSince Sep 23, 2021 Accepting new patients
Singing River Health System Internal Medicine CurrentSince Jul 10, 2011 Accepting new patients
TBD Acquisition II, LLC CurrentSince Feb 20, 2024 Accepting new patients
Singing River Gulfport CurrentSince Sep 23, 2021 Accepting new patients
Singing River Health System Past Accepting new patients

Locations

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

11150 Highway 49
Gulfport, MS 39503
Phone (228) 575-1000

1199 Ocean Springs Rd
Ocean Springs, MS 39564
Phone (228) 875-9363

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 3

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

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Mississippi School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singing River Health System 290 clinicians
Singing River Gulfport 75 clinicians

Practice addresses (Care Compare)

1199 Ocean Springs Rd
Ocean Springs, MS 39564-3421
Phone (228) 875-9363

15200 Community Rd
Gulfport, MS 39503-3085
Phone (228) 575-7112

2809 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 818-0563

2819 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 762-3466

3109 Bienville Blvd
Ocean Springs, MS 39564-4361
Phone (228) 818-1111

350 Cowan Rd
Gulfport, MS 39507-2008
Phone (228) 206-7054

Hospital & facility affiliations

  • Singing River Health System Hospital, Pascagoula, MS, CCN 250040
  • Singing River Gulfport Hospital, Gulfport, MS, CCN 250123

NPI Registry JSON

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

{
    "created_epoch": "1215302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1801059381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 SHELBY LN",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645055",
            "telephone_number": "601-624-8229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535340",
            "telephone_number": "228-809-5510",
            "fax_number": "228-809-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "JOHN",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-06",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "21375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS STATE BOARD OF MEDICAL LICENSURE",
            "identifier": "21375",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gautier, MS

Sources for this page

Verify at the official NPI Registry.