NPIMap

Organization Active NPI

Preventative Medicine & Primary Care LLC

  • Family Medicine Physician
  • Gautier, MS
National Provider Identifier
1992728158
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PREVENTATIVE MEDICINE & PRIMARY CARE LLC
Practice address
3300 Ladnier Rd
Gautier, MS 39553
Phone
(228) 497-2652
Fax
(228) 497-6253
NPI assigned
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Rick D Hoover, DONPI 1962493577
Title
Physician Owner
Phone
(228) 497-2652

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3300 Ladnier Rd
Gautier, MS 39553

Mailing address

3300 Ladnier Rd
Gautier, MS 39553
Phone (228) 497-2652

Other names 1

  • Gautier Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060420000457 MS Part B Supplier - Clinic/Group Practice 7214946177 Receives reassigned benefits from 1 practitioner
Practice locations: Moss Point, MS

National Provider Directory

National Provider Directory
Tax ID family
Gautier Medical Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

8735 Highway 613
Moss Point, MS 39562
Phone (228) 219-3684

8737 Highway 613
Moss Point, MS 39562

6520 Sunscope Dr
Ocean Springs, MS 39564
Phone (228) 875-1177

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992728158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 LADNIER RD",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "39553",
            "telephone_number": "228-497-2652",
            "fax_number": "228-497-6253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 LADNIER RD",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "39553",
            "telephone_number": "228-497-2652",
            "fax_number": "228-497-6253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTATIVE MEDICINE & PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOOVER",
        "authorized_official_first_name": "RICK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHYSICIAN  OWNER",
        "authorized_official_telephone_number": "228-497-2652",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gautier Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gautier, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.