| Care Doc LLC | |
|
4500 13th St Gulfport MS 39501-2515 | |
| (228) 256-1831 | |
| Not Available |
| Full Name | Care Doc LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 4500 13th St, Gulfport, Mississippi |
| Authorized Official Name and Position | Nathan D. Boles (CEO) |
| Authorized Official Contact | 2282363872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Care Doc LLC 1302 44th Ave Gulfport MS 39501-2552 Ph: (228) 236-3872 | Care Doc LLC 4500 13th St Gulfport MS 39501-2515 Ph: (228) 256-1831 |
| NPI Number | 1225505993 |
|---|---|
| Provider Enumeration Date | 10/31/2018 |
| Last Update Date | 09/08/2026 |
| Certification Date | 09/08/2026 |
| Medicare PECOS PAC ID | 7719223957 |
|---|---|
| Medicare Enrollment ID | O20190109002502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225505993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | David Northington |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780690750 PECOS PAC ID: 5991693632 Enrollment ID: I20040305000368 |
| Provider Name | Charles a Stanich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356424576 PECOS PAC ID: 3577563139 Enrollment ID: I20070104000171 |
| Provider Name | Nathan D Boles |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1730277757 PECOS PAC ID: 0244295533 Enrollment ID: I20070322000405 |
| Provider Name | Mousa Maalouf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780799981 PECOS PAC ID: 5698841229 Enrollment ID: I20080905000342 |
| Provider Name | Stephen P Johns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881709053 PECOS PAC ID: 8426114877 Enrollment ID: I20090310000178 |
| Provider Name | Frederick Joseph Pakron |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1538196142 PECOS PAC ID: 4981753696 Enrollment ID: I20090528000267 |
| Provider Name | Joseph Richard Bosarge |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1760465058 PECOS PAC ID: 6002839552 Enrollment ID: I20100518000500 |
| Provider Name | Yvette Susi Folse |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1811929292 PECOS PAC ID: 1850421702 Enrollment ID: I20100619000046 |
| Provider Name | James P Junkins |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386978153 PECOS PAC ID: 5991844847 Enrollment ID: I20100802000584 |
| Provider Name | Amanda Louise Osborne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346548096 PECOS PAC ID: 0446435606 Enrollment ID: I20110503000573 |
| Provider Name | Amy M Dimitriades |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396065694 PECOS PAC ID: 4789855388 Enrollment ID: I20110912000118 |
| Provider Name | Shera Annette Butt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528327517 PECOS PAC ID: 1153556626 Enrollment ID: I20131109000278 |
| Provider Name | Raymond P Blythe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700210432 PECOS PAC ID: 3577786706 Enrollment ID: I20140515001570 |
| Provider Name | Jessica K Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912327289 PECOS PAC ID: 5496972473 Enrollment ID: I20140814002547 |
| Provider Name | Maria Grace Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336495951 PECOS PAC ID: 5496078800 Enrollment ID: I20141216000466 |
| Provider Name | Carla Ann Rushing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023417938 PECOS PAC ID: 8325361504 Enrollment ID: I20141218001914 |
| Provider Name | Ashley Blappert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154728483 PECOS PAC ID: 7517285091 Enrollment ID: I20150413001985 |
| Provider Name | Preethi Harrison |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1144626706 PECOS PAC ID: 2668791922 Enrollment ID: I20150507002034 |
| Provider Name | Benjamin Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669783668 PECOS PAC ID: 0749504678 Enrollment ID: I20150515000414 |
| Provider Name | Erin Kijonka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376993394 PECOS PAC ID: 7315235744 Enrollment ID: I20161018000467 |
| Provider Name | Emily Williams Venatta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437501475 PECOS PAC ID: 7517245269 Enrollment ID: I20161031001894 |
| Provider Name | Steven Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548780588 PECOS PAC ID: 4981978624 Enrollment ID: I20170920000466 |
| Provider Name | Brittany Stewart Everhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891289955 PECOS PAC ID: 6305193152 Enrollment ID: I20180725000380 |
| Provider Name | Dasha N Cowart |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528473329 PECOS PAC ID: 7719264324 Enrollment ID: I20181211003421 |
| Provider Name | William Russell Cullinane |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1730507096 PECOS PAC ID: 7810204443 Enrollment ID: I20200730001703 |
| Provider Name | Nicholas Keaton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245617216 PECOS PAC ID: 6204107816 Enrollment ID: I20200904000681 |
| Provider Name | Kim T Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346994183 PECOS PAC ID: 3173917770 Enrollment ID: I20220224001833 |
| Provider Name | Jonathan a Mihnovets |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578806873 PECOS PAC ID: 3072805472 Enrollment ID: I20220831001394 |
| Provider Name | Patrick Stovall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376004549 PECOS PAC ID: 3971934571 Enrollment ID: I20230831000981 |
| Provider Name | Taylor Brewer Rogers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851080154 PECOS PAC ID: 5698139236 Enrollment ID: I20260218001995 |
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