JACKSON THYROID & ENDOCRINE CLINIC PLLC (NPI# 1134671787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134671787 |
| Entity Type | Organization |
| Organization Name | JACKSON THYROID & ENDOCRINE CLINIC PLLC |
| Practice Address |
971 Lakeland Dr Suite 353 Jackson MS 39216-4643 |
| Practice Telephone | 6019496990 |
| Practice Fax Number | 6019496105 |
| Mailing Telephone | 6019496990 |
| Mailing Fax Number | 6019496105 |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2019-12-13 |
| Authorized Official Name | DR. JOHN WOODY SISTRUNK (OWNER) |
| Authorized Official Telephone | 6019496990 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
15819 | MS | Allopathic & Osteopathic Physicians |
| Street Address |
971 LAKELAND DR SUITE 353 |
| 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 |
| 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 |
| 1417345836 | Kelly Matthew Ray | Nurse Anesthetist, Certified Registered | 971 Lakeland Dr, Suite 202, Jackson, MS 39216-4643 | 2015-01-07 |
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| 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 |
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| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| 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 |
|---|---|---|---|---|
| 1740549864 | Soemiwati Weidris Holland | Internal Medicine | 27 S Cooks Bridge Rd Ste 2-5, Jackson, NJ 08527-2524 | 2012-05-09 |
| 1275543175 | Clemente V. Zulueta, Jr., Md, Pllc | Internal Medicine | 95 Jackson Hts, Ste 201, Jackson, KY 41339-6500 | 2006-08-09 |
| 1477563104 | Amanda Reagan Schiefer | Internal Medicine | 971 Lakeland Drive, Jackson, MS 39126 | 2006-08-08 |
| 1790222651 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1154733392 | Jamie L Brewer | Internal Medicine | 971 Lakeland Dr, Suite 450, Jackson, MS 39216-4643 | 2014-05-22 |
| 1841601861 | Adrienne Webb Maier | Internal Medicine | 1200 N State St Ste 500, Jackson, MS 39202-2027 | 2014-05-13 |
| 1033494372 | Leap One Enterprise Pllc | Internal Medicine | 5160 Galaxie Dr, Jackson, MS 39206-4308 | 2011-10-19 |
| 1356638845 | Christina C. Glover | Internal Medicine | 1200 N State St, Suite 500, Jackson, MS 39202-2000 | 2011-07-05 |
| 1023323029 | Vanessa L. Sandifer, M.d., Pllc | Internal Medicine | 971 Lakeland Drive, Suite 450, Jackson, MS 39216-0450 | 2010-08-13 |
| 1780902155 | Raymond F. Grenfell, IIi., M.d., Pllc | Internal Medicine | 971 Lakeland Drive, Suite 450, Jackson, MS 39216 | 2010-05-11 |
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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.