NPIMap

Individual provider Active NPI

John William Douglas, MD

  • Sleep Medicine (Internal Medicine) Physician
  • Gulfport, MS
National Provider Identifier
1972530335
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
License
8130 Issued in MS
Practice address
15190 Community Rd
Suite 220
Gulfport, MS 39503-3485
Phone
(228) 539-3356
Fax
(228) 539-3225
NPI assigned
Jun 28, 2006
Last updated
Apr 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 08130 MS
Pulmonary Disease Physician 207RP1001X 8130 MS
Sleep Medicine (Internal Medicine) Physician 207RS0012X 8130 MS Primary

Addresses

Primary practice location

15190 Community Rd
Suite 220
Gulfport, MS 39503-3485

Mailing address

PO Box 1810
Gulfport, MS 39502
Phone (228) 575-1194

Other identifiers 2

IdentifierTypeStateIssuer
00019714MedicaidMS
08130OtherMSSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060821000426 MS Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists)Practitioner - Other (Physician) 8123021797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1340 Broad Ave
Gulfport, MS 39501-2460

1340 Broad Ave
Gulfport, MS 39501-2465

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-3152

9424 Three Rivers Rd
Gulfport, MS 39503-4248

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
8130MSMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport CurrentSince Mar 15, 2014 Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
Biloxi Hma LLC Pulmonary Disease Past Accepting new patients

Locations

147 Reynoir St
Ste 204
Biloxi, MS 39530
Phone (228) 374-6296

1756 Popps Ferry Rd
Ste A
Biloxi, MS 39532
Phone (228) 865-3200

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

15286 Community Rd
#B
Gulfport, MS 39503
Phone (228) 831-3106

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451

Interoperability endpoints

  • Direct secure messaging: jdouglas@direct.mhg.com

Organizations & group practices 5

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.

Hospital & facility affiliations 61

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1972530335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "39502",
            "telephone_number": "228-575-1194",
            "fax_number": "228-575-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD",
            "address_2": "SUITE 220",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033485",
            "telephone_number": "228-539-3356",
            "fax_number": "228-539-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "08130",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MS",
            "license": "8130",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MS",
            "license": "8130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00019714",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "08130",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.