NPIMap

Organization Active NPI

Primesource Nursing Services, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Gulfport, MS
National Provider Identifier
1952884652
Registry record updated Sep 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
PRIMESOURCE NURSING SERVICES, INC
Practice address
1500 Broad Ave
Gulfport, MS 39501-3601
Phone
(228) 865-1330
Fax
(228) 865-1331
NPI assigned
Sep 10, 2018
Last updated
Sep 10, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMESOURCE NURSING SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 10, 2018

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

Authorized official

Name
Rhett Plauche
Title
President
Phone
(228) 865-1330

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1500 Broad Ave
Gulfport, MS 39501-3601

Mailing address

PO Box 6705
Gulfport, MS 39506-6705
Phone (228) 865-1330

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050429000745 MS Part B Supplier - Clinic/Group Practice 7113966037 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gulfport, MS; Biloxi, MS

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Primesource Nursing Services Inc3 organizations share this tax ID, including this one
Part of
Primesource Nursing Services Inc

Other organizations with this tax ID 2

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

Locations

1511 Dulles Dr
Lafayette, LA 70506
Phone (337) 215-0950

370 Courthouse Rd
Ste 106
Gulfport, MS 39507
Phone (228) 206-6418

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536537600000",
    "number": "1952884652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6705",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395066705",
            "telephone_number": "228-865-1330",
            "fax_number": "228-865-1331"
        },
        {
            "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": "228-865-1330",
            "fax_number": "228-865-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMESOURCE NURSING SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMESOURCE NURSING SERVICES, INC",
        "enumeration_date": "2018-09-10",
        "last_updated": "2018-09-10",
        "status": "A",
        "authorized_official_last_name": "PLAUCHE",
        "authorized_official_first_name": "RHETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-865-1330"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Sep 10, 2018; 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.