NPIMap

Individual provider Active NPI

John Nolan Grady, M.D.

  • Hospitalist Physician
  • Gulfport, MS
National Provider Identifier
1871933291
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
23986 Issued in MS
Practice address
4500 13TH St
Gulfport, MS 39501-2569
Phone
(228) 867-4396
NPI assigned
Jun 29, 2013
Last updated
Aug 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 23986 MS
Hospitalist Physician 208M00000X 23986 MS Primary

Addresses

Primary practice location

4500 13TH St
Gulfport, MS 39501-2569

Mailing address

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

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
I20160811000458 MS Practitioner - Internal Medicine 0143547190 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in Shreveport, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians
GSW Medical LLCGroup PAC ID 1850779307, 4 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

1440 Central Ave E
Wiggins, MS 39577-9602
Phone (601) 928-6700

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 218-2226

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23986MSMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
GSW Medical, LLC Internal Medicine CurrentSince Jun 1, 2022 Accepting new patients
Grady Consulting Services, LLC Internal Medicine Current Accepting new patients
Comprehensive Hospitalists of Ms, LLC Hospitalist CurrentSince Sep 18, 2016 Accepting new patients
Comprehensive Hospitalists of Ms, LLC Hospitalist CurrentSince Sep 18, 2016 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Jul 1, 2016 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
538 Menge Avenue Operations, LLC Past Accepting new patients
Select Specialty Hospital - Gulf Coast Inc Past Accepting new patients
Gulfport Healthcare LLC Past Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients

Locations

1105 Earl Frye Blvd
Amory, MS 38821
Phone (662) 256-7111

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

1500 Broad Ave
Gulfport, MS 39501
Phone (228) 236-4262

1520 Broad Ave
Ste 300
Gulfport, MS 39501
Phone (228) 575-7500

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

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Pass Christian Health and Rehabilitation CenterPass Christian, MS, CCN 255287 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2022
Jul 1, 2022

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1372464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1871933291",
    "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": "228-575-1194",
            "fax_number": "228-575-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 13TH ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012569",
            "telephone_number": "228-867-4396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADY",
        "first_name": "JOHN",
        "middle_name": "NOLAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-29",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "23986",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MS",
            "license": "23986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.