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CENTERWELL SENIOR PRIMARY CARE-GULFPORT
NPI 1003528092
Internal Medicine in Gulfport, MS

Active since December 21, 2022CLIA Certified · 3 labs
12057 HIGHWAY 49 STE C, GULFPORT, MS 39503(228) 832-9385(877) 504-6444 Get Directions Write a Review

NPPES record last updated: July 3, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 3, 2024, Dec 21, 2022 (2 updates tracked since 2022).

About Centerwell Senior Primary Care-gulfport NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTERWELL SENIOR PRIMARY CARE-GULFPORT (NPI 1003528092) is a healthcare organization registered as an internal medicine in Gulfport, Mississippi and active in the NPI registry since December 2022. The organization holds 3 active CLIA laboratory certificates and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1003528092
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE MS PC
Location Address12057 HIGHWAY 49 STE CGulfport, MS 39503-3177
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000
Phone(228) 832-9385
Fax(877) 504-6444
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateDecember 21, 2022
Last NPPES UpdateJuly 3, 20242 updates tracked since enumeration
NPPES CertifiedJuly 3, 2024
✔ NPI 1003528092 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedGeneral PracticeTaxonomy 208D00000X
12057 HIGHWAY 49 STE C, Gulfport, MS 39503
Open in Google Maps ↗

Other Names 1

Doing Business AsCenterwell Senior Primary Care-gulfport

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2278609

Centerwell Senior Primary Care - Gulfport · Gulfport, MS
Active · expires Mar 20, 2027
CLIA Number25D2278609
Laboratory TypePhysician Office
Certificate Effective DateMarch 21, 2025
Certificate Expiration DateMarch 20, 2027
Laboratory DirectorDr. Earl K. Magee
Laboratory Phone(228) 832-9385
Laboratory LocationCenterwell Senior Primary Care - Gulfport12057 Us Hwy 49 Ste C, Gulfport, MS 39503
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 03D2260206

Centerwell Senior Primary Care-Peoria · Peoria, AZ
Active · expires May 15, 2028
CLIA Number03D2260206
Laboratory TypePhysician Office
Certificate Effective DateMay 16, 2026
Certificate Expiration DateMay 15, 2028
Laboratory DirectorDr. Sahar Zuberi
Laboratory Phone(407) 447-7120
Laboratory LocationCenterwell Senior Primary Care-Peoria10280 N 91st Ave, Peoria, AZ 85345
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 19D2298926

Centerwell Senior Primary Care-Marrero · Marrero, LA
Active · expires Feb 9, 2028
CLIA Number19D2298926
Laboratory TypePhysician Office
Certificate Effective DateFebruary 10, 2026
Certificate Expiration DateFebruary 9, 2028
Laboratory DirectorEarl L. Magee
Laboratory Phone(407) 447-7120
Laboratory LocationCenterwell Senior Primary Care-Marrero5045 Lapalco Blvd, Marrero, LA 70072
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MITCHELL ADAM SANFORD
Family Medicine
12057 HIGHWAY 49 STE C
GULFPORT, MS 39503
Harrison County (228) 832-9385
MICHAELA CHEYENNE WELLS NP-C
Nurse Practitioner (Family)
12057 HIGHWAY 49 STE C
GULFPORT, MS 39503
Harrison County (228) 832-9385
MRS. ASHLEIGH BROOKE MOORE NP-C
Nurse Practitioner (Family)
12057 HIGHWAY 49 STE C
GULFPORT, MS 39503
Harrison County (228) 832-9385

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centerwell Senior Primary Care Ms PC's NPI number?

The NPI number for Centerwell Senior Primary Care Ms PC is 1003528092. It was assigned to this organization in the NPPES registry on December 21, 2022. The provider is doing business as Centerwell Senior Primary Care-Gulfport.

Where is Centerwell Senior Primary Care Ms PC located?

Centerwell Senior Primary Care Ms PC is located at 12057 Highway 49 Ste C, Gulfport, MS 39503. The listed phone number is (228) 832-9385.

What is Centerwell Senior Primary Care Ms PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Centerwell Senior Primary Care Ms PC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Centerwell Senior Primary Care Ms PC was last updated on July 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.