NPIMap

Organization Active NPI

Memorial Hospital at Gulfport

Doing business as Physicians Clinic at MHG

  • Pediatrics Physician
  • Bay St Louis, MS
National Provider Identifier
1902138639
Registry record updated Jul 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MEMORIAL HOSPITAL AT GULFPORT
Doing business as
Physicians Clinic at MHG
Practice address
835 Thames Ave
Suite B
Bay St Louis, MS 39520-5005
Phone
(228) 463-0824
Fax
(228) 463-0827
NPI assigned
Feb 5, 2010
Last updated
Jul 14, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2012

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

Authorized official

Name
Mr. Jeff T Steiner
Title
VP of Finance
Phone
(228) 865-3106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

835 Thames Ave
Suite B
Bay St Louis, MS 39520-5005

Mailing address

PO Box 555
Biloxi, MS 39533-0555
Phone (228) 864-0854

Other identifiers 1

IdentifierTypeStateIssuer
02976571MedicaidMS

Other names 1

  • PHYSICIANS CLINIC AT MHG Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080515000774 MS Part A Provider - Hospital 9537062997 This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902138639. Details of each certification follow.

Hospital certification: CCN 250019

Legal name
MEMORIAL HOSPITAL AT GULFPORT
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 19, 2009
Beds
445
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
4500 13TH St
Gulfport, MS 39501-2515
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial Hospital at GulfportCCN 250019 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

835 Thames Ave
Ste B
Bay St Louis, MS 39520
Phone (228) 463-0824

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Ajm Oustalet Individual Corporate OfficerBoard Member Mar 1, 2009 5%
Peggy L Noonan Individual Corporate DirectorDirector, Business Services May 1, 2020 5%
W-2 Managing EmployeeDirector, Business Services Jan 1, 2006 5%
Kent Nicaud Individual Corporate DirectorChief Executive Officer Nov 1, 2008
W-2 Managing EmployeeCeo Nov 1, 2008
Thaddeus Carter Individual Corporate OfficerBoard Member Aug 1, 2017 5%
Claire Tindell Individual Corporate OfficerBoard Member Jan 1, 2019 5%
Harrison County Board of Supervisors Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Carrolyn Hamilton Individual Corporate Director Aug 10, 2009
David H White Individual Corporate Director Sep 17, 1993
City of Gulfport Organization, Gulfport, MS 5% Or Greater Direct Ownership Interest Feb 15, 1989 50%
Jennifer Dumal Individual W-2 Managing Employee Feb 8, 1998
Carlos Bell Individual Corporate OfficerBoard Secretary Nov 26, 2018 5%

Practitioners & affiliated clinicians

Affiliated clinicians 765

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

View all 765

NPI Registry JSON

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

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342224000000",
    "number": "1902138639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 555",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395330555",
            "telephone_number": "228-864-0854",
            "fax_number": "228-865-1457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 THAMES AVE",
            "address_2": "SUITE B",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395205005",
            "telephone_number": "228-463-0824",
            "fax_number": "228-463-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL AT GULFPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-05",
        "last_updated": "2012-07-14",
        "status": "A",
        "authorized_official_last_name": "STEINER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "228-865-3106",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02976571",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICIANS CLINIC AT MHG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bay St Louis, MS

Sources for this page

Verify at the official NPI Registry.