Primesource Nursing Services, Inc

Key facts

NPI

1952884652

Entity type

Organization (NPI type 2)

Primary specialty

Psychiatric/Mental Health Nurse Practitioner 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

Organization subpart

Yes

Parent organization (as reported)

PRIMESOURCE NURSING SERVICES, INC

Authorized official

Name

Rhett Plauche

Title

President

Phone

(228) 865-1330

Other NPIs on the same Medicare enrollment 1

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

• Primesource Nursing Services, Inc Family Nurse Practitioner · Gulfport, MS · NPI 1962573170
  Same enrollment O20050429000745

Corporate family (same tax ID) 2

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

• Primesource Nursing Services, Inc Nurse Practitioner · Biloxi, MS · NPI 1114583994
  NPD tax ID
• Primesource Nursing Services, Inc Nurse Practitioner · Gulfport, MS · NPI 1801987870
  NPD tax ID

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer S Brechtel, PMHNP-BC Psychiatric/Mental Health Nurse Practitioner · Gulfport, MS · NPI 1649370503
  NPD PSYCHIATRIC/MENTAL HEALTH
• Phillip D Compton II, M.D. Internal Medicine Physician · Gulfport, MS · NPI 1578591186
  NPD
• Jennifer Leigh Galle, NP-C Nurse Practitioner · Gulfport, MS · NPI 1073747564
  NPD PSYCHIATRIC/MENTAL HEALTH
• Lucy B Hodges, FPNP Psychiatric/Mental Health Nurse Practitioner · Greenwood, MS · NPI 1639331994
  NPD PSYCHIATRIC/MENTAL HEALTH
• Lauren Renee Jandorf, FNP-C Family Nurse Practitioner · Gulfport, MS · NPI 1669002333
  NPD
• Jeri Hughes Squyres, LCSW Clinical Social Worker · Biloxi, MS · NPI 1538107164
  NPD CLINICAL
• Kelly Lynn Tinson, NP-C Family Nurse Practitioner · Biloxi, MS · NPI 1407336423
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MS

Medicare enrollment records

National Provider Directory

Tax ID family

Primesource Nursing Services Inc (3 organizations share this tax ID)

Part of

Primesource Nursing Services Inc

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 10, 2018.

{
    "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

• Iccess C Price
• Kathryn E Price
• Kayla Elise Price, DO
• Primary Care Medical Center of Gulfport, PLLC
• Primesource Nursing Services, Inc
• Primesource Nursing Services, Inc
• Tanisha Nedelka Prins, LCSW, BCD
• Sally M Proffitt, FNP-C
• Prosthetic Solutions Inc.
• Laura Puffer, M.ED, LPC, NCC

All providers in Gulfport, MS · Psychiatric/Mental Health Nurse Practitioner in Mississippi