NPIMap

Organization Active NPI

Memorial Hospital at Gulfport

  • Skilled Nursing Facility
  • Gulfport, MS
National Provider Identifier
1801905310
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
193 Issued in MS
Legal business name
MEMORIAL HOSPITAL AT GULFPORT
Practice address
1500 Broad Ave
Gulfport, MS 39501-3601
Phone
(228) 868-1314
Fax
(228) 863-8966
NPI assigned
Aug 29, 2006
Organization subpart
Yes
Parent organization
MEMORIAL HOSPITAL AT GULFPORTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 193 MS Primary

Addresses

Primary practice location

1500 Broad Ave
Gulfport, MS 39501-3601

Mailing address

1500 Broad Ave
Gulfport, MS 39501-3601
Phone (228) 868-1314

Other identifiers 1

IdentifierTypeStateIssuer
0230135MedicaidMS

Other names 1

  • Driftwood Nursing Center Doing business as

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190703002627 MS Part A Provider - Skilled Nursing Facility 9537062997 Practice locations: Gulfport, MS

Skilled nursing facility certification: CCN 255290

Legal name
MEMORIAL HOSPITAL AT GULFPORT
Doing business as
DRIFTWOOD NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 2002
Last certification
Oct 31, 2024
Beds
151
Ownership / control type
Other Nonprofit
Multi-facility organization
Memorial Hospital of Gulfport
Organization structure
OtherNon-profit
Enrollment address
1500 Broad Ave
Gulfport, MS 39501-3601
Nursing home name
DRIFTWOOD NURSING CENTER

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Driftwood Nursing CenterCCN 255290
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
Sep 1, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
15199.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0721357Memorial Driftwood Nursing Center1500 Broad Avenue, Gulfport, MS 39501Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosp ER Dept21 organizations share this tax ID, including this one
Part of
Memorial Hosp ER Dept

Other organizations with this tax ID 20

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

View all 20

Locations

1500 Broad Ave
#100
Gulfport, MS 39501

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Myron McCoo Individual Corporate OfficerVP Human Resources Aug 19, 2019 5%
W-2 Managing EmployeeVP Human Resources Aug 19, 2019 5%
Operational/Managerial ControlVP Human Resources Aug 19, 2019 5%
Peggy L Noonan Individual Corporate DirectorDirector, Business Services and Med Apr 1, 2020 5%
Kent Nicaud Individual Corporate OfficerChief Executive Officer Jun 23, 2019 100%
W-2 Managing EmployeeChief Executive Officer Jun 23, 2019 100%
Operational/Managerial ControlChief Executive Officer Jun 23, 2019 100%
Haley Zelenka Individual Corporate OfficerVP General Counsel Jun 23, 2019 5%
W-2 Managing EmployeeVP General Counsel Jun 23, 2019 5%
Operational/Managerial ControlVP General Counsel Jun 23, 2019 5%
Harrison County Board of Supervisors Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Jun 23, 2019 50%
City of Gulfport Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Jun 23, 2019 50%
Jennifer Dumal Individual Corporate OfficerChief Nursing Officer Jun 23, 2019 5%
W-2 Managing EmployeeChief Nursing Officer Jun 23, 2019 5%
Operational/Managerial ControlChief Nursing Officer Jun 23, 2019 5%
Brandie Morace Individual W-2 Managing EmployeeNursing Home Adminstrator Jun 23, 2019 5%
Eugene Thomas Individual Contracted Managing EmployeeChief Information Officer Jun 23, 2019 5%
Corporate OfficerChief Information Officer Jun 23, 2019 5%
Operational/Managerial ControlChief Information Officer Jun 23, 2019 5%
Strategic Management LLC Organization, Wiggins, MS LLC Operational/Managerial Control Jun 23, 2019 90%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Hospital BiloxiBiloxi, MS, CCN 250175 Hospital 5% Or Greater Indirect Ownership Interest (100%) Feb 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

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

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1801905310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395013601",
            "telephone_number": "228-868-1314",
            "fax_number": "228-863-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 BROAD AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395013601",
            "telephone_number": "228-868-1314",
            "fax_number": "228-863-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "enumeration_date": "2006-08-29",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MS",
            "license": "193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230135",
            "state": "MS"
        }
    ],
    "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": [
        {
            "organization_name": "Driftwood Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Driftwood Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.