NPIMap

Individual provider Active NPI

Tijuana Lisette Freeman, M.D.

  • Pediatrics Physician
  • Ocean Springs, MS
National Provider Identifier
1952366080
Registry record updated Dec 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
15040 Issued in MS
Practice address
3650 Groveland Rd
Ocean Springs, MS 39564-5753
Phone
(228) 875-0780
Fax
(228) 875-1009
NPI assigned
Apr 20, 2006
Last updated
Dec 29, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 15040 MS Primary
Pediatrics Physician 208000000X E-1828 AR

Addresses

Primary practice location

3650 Groveland Rd
Ocean Springs, MS 39564-5753

Mailing address

3650 Groveland Rd
Ocean Springs, MS 39564-5753
Phone (228) 875-0780

Other identifiers 3

IdentifierTypeStateIssuer
1222017OtherARUNITED HEALTH CARE
1832000000OtherARQUAL CHOICE
135418001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-1828ARMDPediatrics Physician
15040MSMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Children's Clinic, PA Past Accepting new patients
Gulf Coast Children's Clinic Pediatrics Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325116800000",
    "number": "1952366080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 GROVELAND RD",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645753",
            "telephone_number": "228-875-0780",
            "fax_number": "228-875-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 GROVELAND RD",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395645753",
            "telephone_number": "228-875-0780",
            "fax_number": "228-875-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "TIJUANA",
        "middle_name": "LISETTE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2011-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "15040",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-1828",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1222017",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUAL CHOICE",
            "identifier": "1832000000",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135418001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean Springs, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.