MISSISSIPPI BAPTIST MEDICAL CENTER, INC. (NPI# 1124155809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124155809 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI BAPTIST MEDICAL CENTER, INC. |
| Other Organization Name | MISSISSIPPI BAPTIST MEDICAL CENTER RAILROAD MEDICARE |
| Practice Address |
1225 N State St Jackson MS 39202-2064 |
| Mailing Address |
350 N Humphreys Blvd Memphis TN 38120-2177 |
| Practice Telephone | 6019681362 |
| Practice Fax Number | 6012924592 |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-09-30 |
| Authorized Official Name | GREGORY M DUCKETT (SR VP/ CLO) |
| Authorized Official Telephone | 9012275233 |
| Is Organization Subpart | Y |
| Parent Organization Name | BAPTIST MEMORIAL HEALTH CARE CORP. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Mississippi Baptist Medical Center Railroad Medicare | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609485440 | Mississippi Baptist Medical Center, Inc. | Clinical Medical Laboratory | 1225 N State St, Jackson, MS 39202-2064 | 2020-07-28 |
| 1255882890 | Mississippi Baptist Medical Center, Inc. | Pharmacy | 1225 N State St, Jackson, MS 39202-2064 | 2016-10-19 |
| 1730480120 | Mississippi Baptist Medical Center, Inc. | General Acute Care Hospital | 1225 N State St, Jackson, MS 39202-2064 | 2010-11-16 |
| 1528289592 | Mississippi Baptist Medical Center, Inc. | General Acute Care Hospital | 1225 N State St, Jackson, MS 39202-2064 | 2007-05-01 |
| 1467589556 | Mississippi Baptist Medical Center, Inc. | Psychiatry & Neurology | 1225 N State St, Jackson, MS 39202-2064 | 2007-02-27 |
| 1710909585 | Mississippi Baptist Medical Center, Inc. | General Acute Care Hospital | 1225 N State St, Jackson, MS 39202-2064 | 2006-07-24 |
| 1417984360 | Mississippi Baptist Medical Center, Inc. | Psychiatric Unit | 1225 N State St, Jackson, MS 39202-2064 | 2006-06-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MISSISSIPPI BAPTIST MEDICAL CENTER, INC. | 1225 N State St, Jackson, MS 39202-2064 |
| Street Address |
1225 N STATE ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2064 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013919216 | Richard B Friedman | Radiology | 1225 N State St, Jackson, MS 39202-2064 | 2005-06-01 |
| 1326649336 | Sharron Rena Brown | Nurse Practitioner | 1225 N State St, Jackson, MS 39202-2097 | 2020-11-05 |
| 1861009714 | April Stevenson Corcoran | Registered Nurse | 1225 N State St, Jackson, MS 39202-2064 | 2020-09-24 |
| 1609485440 | Mississippi Baptist Medical Center, Inc. | Clinical Medical Laboratory | 1225 N State St, Jackson, MS 39202-2064 | 2020-07-28 |
| 1912530569 | Brandi Burge Wagner | Nurse Practitioner | 1225 N State St, Jackson, MS 39202-2064 | 2020-02-21 |
| 1760028955 | Erin Jones | Registered Nurse | 1225 N State St, Jackson, MS 39202-2064 | 2019-11-21 |
| 1780229641 | Lauren Blakeney | Nurse Practitioner | 1225 N State St, Jackson, MS 39202-2064 | 2019-11-14 |
| 1417591322 | Lou Ann Wells | Registered Nurse | 1225 N State St, Jackson, MS 39202-2064 | 2019-11-04 |
| 1861043531 | Jessica Candace Cody | Anesthesiology | 1225 N State St, Jackson, MS 39202-2064 | 2019-09-24 |
| 1386290955 | Brady K Lowery | Nurse Practitioner | 1225 N State St, Jackson, MS 39202-2064 | 2019-08-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144792169 | Snake River Consulting LLC | Psychologist | 430 Pine Dr, Jackson, WY 83001-8417 | 2019-01-02 |
| 1972834604 | Sue C Radtke | Psychologist | 4476 Bittersweet Ct, Jackson, WI 53037-9754 | 2010-01-20 |
| 1043549280 | University of Mississippi Medical Center | Psychologist | 2500 N State St # H819-01, Jackson, MS 39216-4500 | 2009-12-17 |
| 1356511562 | John Patterson Thorn | Psychologist | 270 Veronica Lane, Suite C-1, Jackson, WY 83001-0000 | 2008-03-04 |
| 1013109552 | Terri Martin Revelle | Psychologist | 111 E. Jefferson St., Jackson, NC 27845 | 2007-08-17 |
| 1184830143 | Toby S Altfeld | Psychologist | 156 C West University Parkway, Jackson, TN 38305 | 2007-05-15 |
| 1497968911 | Mollie Wyatt | Psychologist | 4055 I-55 North, Suite 293, Jackson, MS 39211 | 2007-05-08 |
| 1124249719 | John David Vickery | Psychologist | 3363 Highway 45 North, Jackson, TN 38305 | 2007-05-01 |
| 1215157425 | Angela O'briant Herzog | Psychologist | Forty-five Hundred Interstate Fifty-five North, Suite 208, Jackson, MS 39211 | 2007-04-27 |
| 1295877165 | Rose Margaret Hochheiser | Psychologist | 140 King Street, Jackson, WY 83001 | 2007-02-13 |
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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.