Memorial Hospital at Gulfport
Organization Active NPI Neurology Physician · Diamondhead, MS
NPI 1972835619 · NPPES record last updated Feb 7, 2013
Key facts
- NPI
- 1972835619
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- Legal business name
- MEMORIAL HOSPITAL AT GULFPORT
- Practice address
- 4300 Leisure Time Dr
Suite B
Diamondhead, MS 39525-3241 - Phone
- (228) 255-6129
- Fax
- (228) 255-6431
- NPI assigned
- Feb 5, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeff T Steiner
- Title
- VP of Finance
- Phone
- (228) 865-3106
Affiliated clinicians 765
-
Lauren Ackerman, PA
-
Casey Adams, CNP
-
Daniel Adams, MD
-
Satjit Adlakha, D.O.
-
Ahmad Agha, M.B.B.S.
-
Belinda Alexander, M.D.
-
Amy Allen, CRNP
-
Summer Lea Allen, MD
-
Brian Thomas Anthony, M.D.
-
Lisa Yarborough Anthony, N.P.
-
Kathleen Cecilia Arnold, A.N.P.
-
Nabil Azar, M.D.
-
Lissa Kelly Baber, AGACNP
-
Seema Anil Badve, MD
-
Rainna P Bahadur, M.D.
-
Christine Tracey Balius, MSN, FNP-C
-
Anne Elizabeth Baranano, M.D.
Medicare Care Compare: Hospital
- Listed as
- Memorial Hospital at Gulfport
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Hospital certification: CCN 250019
- Legal name
- MEMORIAL HOSPITAL AT GULFPORT
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Aug 19, 2009
- Beds
- 445
- Ownership / control type
- Local
- Organization structure
- Other · Non-profit
- Enrollment address
- 4500 13TH St
Gulfport, MS 39501-2515 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Ajm Oustalet |
Corporate Officer |
Mar 1, 2009 | 5% |
| Peggy L Noonan |
Corporate Director |
May 1, 2020 | 5% |
| W-2 Managing Employee |
Jan 1, 2006 | 5% | |
| Kent Nicaud |
Corporate Director |
Nov 1, 2008 | |
| W-2 Managing Employee |
Nov 1, 2008 | ||
| Thaddeus Carter |
Corporate Officer |
Aug 1, 2017 | 5% |
| Claire Tindell |
Corporate Officer |
Jan 1, 2019 | 5% |
| Harrison County Board of Supervisors |
5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Carrolyn Hamilton |
Corporate Director | Aug 10, 2009 | |
| David H White |
Corporate Director | Sep 17, 1993 | |
| City of Gulfport |
5% Or Greater Direct Ownership Interest | Feb 15, 1989 | 50% |
| Jennifer Dumal |
W-2 Managing Employee | Feb 8, 1998 | |
| Carlos Bell |
Corporate Officer |
Nov 26, 2018 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080515000774 | MS | Part a Provider - Hospital | 9537062997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician |
207RR0500X | |||
| Neurology Physician |
2084N0400X | Yes |
Addresses
Primary practice location
4300 Leisure Time Dr
Suite B
Diamondhead, MS 39525-3241
Mailing address
PO Box 555
Biloxi, MS 39533-0555
Phone (228) 864-0854
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02203599 | Medicaid | MS |
Other names
- PHYSICIANS CLINIC AT MHG
Other providers in Diamondhead, MS
- Amber Hope McIlwain
- Colleen McMahon
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Memorial Hospital at Gulfport
- Ronald Boa Miller Jr.
- Elizabeth Milner
- Mississippi CVS Pharmacy, LLC
- Andrea M Mitchell
- Mmemorial Hospital at Gulfport
All providers in Diamondhead, MS · Neurology Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.