ST. DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1124252788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124252788 |
| Entity Type | Organization |
| Organization Name | ST. DOMINIC MEDICAL ASSOCIATES LLC |
| Other Organization Name | INTERNAL MEDICINE GROUP |
| Practice Address |
971 Lakeland Dr Suite 250 Jackson MS 39216-4643 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6019821283 |
| Mailing Telephone | 6012005986 |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2019-07-22 |
| 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 | 207R00000X | Internal Medicine | MS | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Internal Medicine Group | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 970 Lakeland Dr Ste 43, Jackson, MS 392164634 | 6012004850 | 6012004838 |
| 106 Highland Way Ste 200, Madison, MS 391106933 | 6012004141 | 6012004150 |
| 106 Lake Vista Pl, Brandon, MS 390476384 | 6019192924 | 6019927347 |
| 970 Lakeland Dr Ste 40, Jackson, MS 392164640 | 6012004850 | 6012004838 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902374085 | St. Dominic Medical Associates LLC | Internal Medicine | 970 Lakeland Dr Ste 43, Jackson, MS 39216-4634 | 2018-11-07 |
| 1174686182 | St. Dominic Medical Associates LLC | Neurological Surgery | 971 Lakeland Dr. Suite 1250, Jackson, MS 39216-0000 | 2006-12-19 |
| 1710040712 | St. Dominic Medical Associates LLC | Family Medicine | 1050 River Oaks Dr, Suite 100, Flowood, MS 39232-9564 | 2006-12-19 |
| 1245393255 | St. Dominic Medical Associates LLC | Family Medicine | 106 Highland Way, Suite 103, Madison, MS 39110-6929 | 2006-12-19 |
| 1407920549 | St. Dominic Medical Associates LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2006-11-20 |
| Street Address |
971 LAKELAND DR SUITE 250 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4643 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588661789 | Maurice James | Ophthalmology | 971 Lakeland Dr, Ste 563, Jackson, MS 39216-4607 | 2005-07-01 |
| 1891226643 | Matthew Milling | Nurse Anesthetist, Certified Registered | 971 Lakeland Dr, Suite 202, Jackson, MS 39216-4643 | 2017-03-23 |
| 1134667843 | Bonney Neill Simmons | Nurse Practitioner | 971 Lakeland Dr, Jackson, MS 39216-4643 | 2017-02-02 |
| 1437694320 | Kristen Degelman | Nurse Practitioner | 971 Lakeland Dr, Suite 401, Jackson, MS 39216-4643 | 2016-12-30 |
| 1134671787 | Jackson Thyroid & Endocrine Clinic Pllc | Internal Medicine | 971 Lakeland Dr, Suite 353, Jackson, MS 39216-4643 | 2016-10-31 |
| 1609223205 | Sally Sullivan | Nurse Anesthetist, Certified Registered | 971 Lakeland Dr, Jackson, MS 39216-4643 | 2016-05-24 |
| 1932576998 | Misty Gaines | Nurse Practitioner | 971 Lakeland Dr, Suite 657, Jackson, MS 39216-4643 | 2015-08-26 |
| 1659755676 | Angela B. Mccallum | Nurse Practitioner | 971 Lakeland Dr, Jackson, MS 39216-4643 | 2015-07-20 |
| 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 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215556048 | Hannah Roberts Badon | Internal Medicine | 2450 Wild Valley Dr, Jackson, MS 39211-6224 | 2020-04-12 |
| 1649809476 | Rachel Horn Mullins | Internal Medicine | 5379 Fairway St, Jackson, MS 39211-4251 | 2020-04-03 |
| 1861800666 | Michigan Continuum Care Pllc | Internal Medicine | 1310 Greenwood Ave., Jackson, MI 49203 | 2014-07-25 |
| 1356605752 | Jeremy Taylor | Internal Medicine | 971 Lakeland Dr Ste 450, Jackson, MS 39216-4615 | 2012-06-29 |
| 1134416019 | Zubair Khan | Internal Medicine | 3291 Creekwood Cir, Jackson, WI 53037-8927 | 2011-06-29 |
| 1801181466 | Anne Marie Shute | Internal Medicine | 7 Windwood Dr, Jackson, TN 38305-8835 | 2011-06-12 |
| 1487945648 | Howard Carroll Friday | Internal Medicine | 4019 Old Canton Rd., Jackson, MS 39216 | 2011-04-22 |
| 1801195003 | Mahir H Alsalman | Internal Medicine | 3100 Cooper St, Jackson, MI 49201-7545 | 2011-03-28 |
| 1912138967 | Tatum Medical Clinic | Internal Medicine | 5903 Ridgewood Rd Ste 330, Jackson, MS 39211-3702 | 2009-08-06 |
| 1306089040 | Hussein Othman | Internal Medicine | 205 Page Ave Ste B, Jackson, MI 49201-2462 | 2009-04-10 |
| Find all providers in JACKSON | ||||
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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.