Individual provider Active NPI

John Ben Hassam, D.C. CHIROPRACTOR

  • Chiropractor
  • Gulfport, MS
National Provider Identifier
1902859176
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1353 Issued in MS
Practice address
2045 E Pass Rd Ste B
Gulfport, MS 39507-3761
Phone
(228) 896-7574
Fax
(228) 896-7579
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038009480 IL
Chiropractor 111N00000X 1353 MS Primary

Addresses

Primary practice location

2045 E Pass Rd Ste B
Gulfport, MS 39507-3761

Mailing address

2045 E Pass Rd Ste B
Gulfport, MS 39507-3761
Phone (228) 896-7574

Other identifiers 1

IdentifierTypeStateIssuer
1902859176OtherILNPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220719001805 MS Practitioner - Chiropractic 2062482748 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1353MSMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Big River Chiropractic Horn Lake PLLC Chiropractor CurrentSince Jan 2, 2025 Accepting new patients
Jernigan Chiropractic Clinic Inc Chiropractor CurrentSince Mar 20, 2023 Accepting new patients
Align Chiropractic PC PastSince Jun 2, 2024 Accepting new patients

Locations

2045 E Pass Rd
#B
Gulfport, MS 39507
Phone (228) 896-7574

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1902859176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 E PASS RD STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073761",
            "telephone_number": "228-896-7574",
            "fax_number": "228-896-7579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 E PASS RD STE B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073761",
            "telephone_number": "228-896-7574",
            "fax_number": "228-896-7579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASSAM",
        "first_name": "JOHN",
        "middle_name": "BEN",
        "name_prefix": "Dr.",
        "credential": "D.C. CHIROPRACTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009480",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MS",
            "license": "1353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1902859176",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 20, 2023; 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.