ST DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1083032171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083032171 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC MEDICAL ASSOCIATES LLC |
| Other Organization Name | ST DOMINIC RALEIGH FAMILY PRACTICE |
| Practice Address |
342 Magnolia Dr Raleigh MS 39153-6012 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6012006809 |
| Practice Fax Number | 6012005929 |
| Mailing Telephone | 6012004749 |
| Mailing Fax Number | 6012005929 |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2019-07-02 |
| Authorized Official Name | DANIELLE STUART (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 6012004880 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST DOMINIC JACKSON MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 16442 | MS | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| St Dominic Raleigh Family Practice | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 360 Simpson Highway 149 Ste 370, Magee, MS 391113843 | 6018491530 | 6018491535 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548698608 | St Dominic Medical Associates LLC | Family Medicine | 1297 West Government Street, Brandon, MS 39042 | 2013-10-28 |
| 1093032849 | St Dominic Medical Associates LLC | Family Medicine | 969 Lakeland Dr St Thomas Hall, Jackson, MS 39216-4606 | 2010-05-03 |
| 1326646845 | St Dominic Medical Associates LLC | Dermatology | 106 Highland Way Ste 203, Madison, MS 39110-6933 | 2020-10-16 |
| 1356732481 | St Dominic Medical Associates LLC | Internal Medicine | 971 Lakeland Dr, Suite, Jackson, MS 39216-4643 | 2015-02-11 |
| 1689063067 | St Dominic Medical Associates LLC | Urology | 971 Lakeland Dr, Suite 360, Jackson, MS 39216-4643 | 2015-01-22 |
| 1508263179 | St Dominic Medical Associates LLC | Nurse Practitioner | 890 Lakeland Dr, Jackson, MS 39216-4644 | 2014-11-26 |
| 1316361686 | St Dominic Medical Associates LLC | Surgery | 106 Highland Way, Ste 200, Madison, MS 39110-6929 | 2014-02-07 |
| 1215350152 | St Dominic Medical Associates LLC | Psychiatry & Neurology | 971 Lakeland Dr, Suite 557, Jackson, MS 39216-4643 | 2014-01-29 |
| 1124452859 | St Dominic Medical Associates LLC | Pain Medicine | 970 Lakeland Dr, Suite 45, Jackson, MS 39216-4635 | 2013-08-29 |
| 1285987578 | St Dominic Medical Associates LLC | Hospitalist | 969 Lakeland Dr, Jackson, MS 39216 | 2012-10-24 |
| Street Address |
342 MAGNOLIA DR |
| City | RALEIGH |
| State | MS |
| Zip Code | 39153-6012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306869102 | Kenneth Brent Cain | Family Medicine | 342 Magnolia Dr, Raleigh, MS 39153-6012 | 2006-07-25 |
| 1174902134 | Pamela Denise Hardin | Nurse Practitioner | 342 Magnolia Dr, Raleigh, MS 39153-6012 | 2015-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780936740 | Heather Celeste Burt Jordan | Occupational Therapist | 309 Magnolia Road, Rolling Acres Retirement, Raleigh, MS 39153 | 2012-10-15 |
| 1831484609 | Lane Napier Baxter | Dentist | 226 Highway 18 West, Raleigh, MS 39153 | 2011-06-09 |
| 1568626216 | Guardian Angel Healthcare Inc., II | Medicare Defined Swing Bed Unit | 347 Magnolia Drive, Raleigh, MS 39153 | 2008-07-11 |
| 1326178203 | Smith County Ltc, LLC | Nursing Facility/Intermediate Care Facility | 309 Magnolia Drive, Raleigh, MS 39153 | 2007-03-07 |
| 1386705705 | Phil Thompson | Family Medicine | 342 Magnolia Drive, Raleigh, MS 39153 | 2006-12-12 |
| 1962599696 | Bobby D Maddox | Dentist | 207 Sylvarena Ave., Raleigh, MS 39153 | 2006-10-06 |
| 1679660492 | Raleigh Dental Clinic | Dentist | 207 Sylvarena Ave, Raleigh, MS 39153 | 2006-10-05 |
| 1538278734 | Larry Franklin Gibson | Family Medicine | 202 Sylvarena Ave., Raleigh, MS 39153 | 2006-08-30 |
| 1285967653 | Guardian Angel Healthcare Inc., II | Psychiatric Unit | 347 Magnolia Drive, Raleigh, MS 39153 | 2009-09-16 |
| 1588853154 | Family Health Care Clinic, Inc. | Clinic/Center | 226 Whiteoak Ave, Raleigh, MS 39153 | 2007-10-19 |
| Find all providers in zip 39153 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938894 | American Ecare Telehealth Pllc | Family Medicine | 5312 Pomfret Pt, Raleigh, NC 27612-3683 | 2020-06-27 |
| 1093339368 | Nc Telehealth, Pllc | Family Medicine | 1030 N Rogers Ln Ste 121, Raleigh, NC 27610-6083 | 2020-06-02 |
| 1427680917 | Peter Mcilwaine | Family Medicine | 2605 Blue Ridge Rd Ste 300, Raleigh, NC 27607-6475 | 2020-02-12 |
| 1104483387 | Rebecca Jeffries Cloer | Family Medicine | 8331 Bandford Way Ste 101, Raleigh, NC 27615-2765 | 2019-05-23 |
| 1154888154 | Wwc Medical Pllc | Family Medicine | 7800 Falls of Neuse Rd, #99511, Raleigh, NC 27615-9998 | 2019-02-26 |
| 1932683166 | Good Health Urgent & Primary Care Pllc | Family Medicine | 3716 National Dr Ste 208, Raleigh, NC 27612-4863 | 2018-09-24 |
| 1124501085 | Select Medical Services Pllc | Family Medicine | 10931 Raven Ridge Rd Ste 115, Raleigh, NC 27614-6499 | 2018-09-07 |
| 1215419379 | Patrick Orion Finn | Family Medicine | 10010 Falls of The Neuse Rd, Suite 11, Raleigh, NC 27614 | 2018-09-05 |
| 1740768225 | Iam Healthcare, Pllc | Family Medicine | 5509 Cumberland Plain Dr, Raleigh, NC 27616 | 2018-08-06 |
| 1265963938 | David James Mcmullen | Family Medicine | 3320 Executive Dr Ste 214, Raleigh, NC 27609-7489 | 2017-03-24 |
| Find all providers in RALEIGH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.