ST DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1124452859) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124452859 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC MEDICAL ASSOCIATES LLC |
| Other Organization Name | ST DOMINIC PAIN MANAGEMENT CENTER |
| Practice Address |
970 Lakeland Dr Suite 45 Jackson MS 39216-4635 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6012004690 |
| Practice Fax Number | 6012004698 |
| Mailing Telephone | 6012004749 |
| Mailing Fax Number | 6012005929 |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2015-02-04 |
| Authorized Official Name | JENNIFER SINCLAIR (PRESIDENT OF SDMA) |
| Authorized Official Telephone | 6012002000 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST DOMINIC JACKSON MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 08009242 | 05 |
| Other Name | Type Code |
|---|---|
| St Dominic Pain Management Center | Doing Business As Name - Organization |
| 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 |
| 1083032171 | St Dominic Medical Associates LLC | Family Medicine | 342 Magnolia Dr, Raleigh, MS 39153-6012 | 2014-04-04 |
| 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 |
| 1285987578 | St Dominic Medical Associates LLC | Hospitalist | 969 Lakeland Dr, Jackson, MS 39216 | 2012-10-24 |
| Street Address |
970 LAKELAND DR SUITE 45 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255303517 | St Dominic Ambulatory Surgery Center L L C | Clinic/Center | 970 Lakeland Dr, Suite 15, Jackson, MS 39216-4601 | 2006-02-02 |
| 1326689662 | Jessica M Tolar | Nurse Practitioner | 970 Lakeland Dr, Jackson, MS 39216-4635 | 2019-10-07 |
| 1861810889 | Radiation Oncology Associates of Mississippi | Radiology | 970 Lakeland Dr, Suite 34, Jackson, MS 39216-4635 | 2014-04-07 |
| 1780988949 | Holly M Bridges | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2011-01-03 |
| 1023249497 | Lynn Ann Vincent | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2009-08-04 |
| 1578793220 | Valerie C Bailey | Nurse Practitioner | 970 Lakeland Dr, Jackson, MS 39216-4635 | 2009-07-15 |
| 1174757017 | St Dominic Medical Associates LLC | Otolaryngology | 970 Lakeland Dr, Suite 40, Jackson, MS 39216-4635 | 2009-05-06 |
| 1578720231 | Angela Sterling | Nurse Practitioner | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2008-05-20 |
| 1144491580 | Magnolia Woman's Clinic, P.a. | Obstetrics & Gynecology | 970 Lakeland Dr, Suite 43, Jackson, MS 39216-4635 | 2008-03-13 |
| 1811198005 | Philip Lamar Chustz | Internal Medicine | 970 Lakeland Dr, Suite 61, Jackson, MS 39216-4635 | 2007-05-29 |
| 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 | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083194237 | Spectrum Pain Clinics Inc. | Pain Medicine | 23 Sandstone Cir, Jackson, TN 38305-2073 | 2018-08-17 |
| 1982141123 | W.a. Foote Memorial Hospital, Inc | Pain Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-26 |
| 1750789947 | Select Interventional Pain, PC | Pain Medicine | 794 Mcdonough Rd, Suite 108, Jackson, GA 30233-1572 | 2014-12-20 |
| 1548522774 | Neuropathy and Pain Centers of America Holding Company, LLC | Pain Medicine | 300 W Washington Ave, Ste. 250, Jackson, MI 49201-2180 | 2012-06-13 |
| 1932334828 | Advanced Pain Treatment Centers, PC | Pain Medicine | 60 Lynoak Cv, Jackson, TN 38305-2800 | 2009-05-20 |
| 1003025412 | Dr. Jeff Summers Pa | Pain Medicine | 1 Layfair Dr, Ste400, Jackson, MS 39232-9717 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639317274 | Robert A Wiemer Jr. | Pain Medicine | 528-f Klondike Road, Long Beach, MS 39560 | 2009-02-03 |
| 1922218627 | Robert Fortier Bensen | Pain Medicine | 445 Security Sq, Gulfport, MS 39507-1922 | 2007-05-23 |
| 1811098874 | Laurel Pain Clinic Pa | Pain Medicine | 1706 W 12th St, Laurel, MS 39440-2559 | 2006-09-25 |
| 1922092881 | Eric Pearson | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2005-09-07 |
| 1497752760 | Fani B Manney | Pain Medicine | #4 Doctors Dr, Suite C, Ocean Springs, MS 39564 | 2005-07-01 |
| 1417953050 | Steven Thomas Richey | Pain Medicine | 122 Airways Pl, Southaven, MS 38671-5872 | 2005-06-27 |
| 1316558893 | Mississippi Pain Management, Pllc | Pain Medicine | 1080 River Oaks Dr Ste B103, Flowood, MS 39232-7602 | 2020-08-10 |
| 1083193031 | Bacas Interventional Pain Management, LLC | Pain Medicine | 1430 Highway 4 E, Holly Springs, MS 38635-2140 | 2018-08-10 |
| 1356848014 | Flowood Pain Center, LLC | Pain Medicine | 120 Stone Creek Blvd Ste 500, Flowood, MS 39232-8210 | 2018-04-10 |
| 1134596760 | Pain Partners, LLC | Pain Medicine | 1001 14th St, Meridian, MS 39301-4458 | 2015-08-31 |
| Find all providers with the same taxonomy | ||||
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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.