ST DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1548698608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548698608 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC MEDICAL ASSOCIATES LLC |
| Other Organization Name | ST DOMINIC FAMILY PRACTICE BRANDON |
| Practice Address |
1297 West Government Street Brandon MS 39042 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6012004790 |
| Practice Fax Number | 6012004855 |
| Mailing Telephone | 6012004749 |
| Mailing Fax Number | 6012005929 |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2016-12-30 |
| 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 | 207Q00000X | Family Medicine | 18818 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 02751790 | 05 |
| Other Name | Type Code |
|---|---|
| St Dominic Family Practice Brandon | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 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 |
1297 WEST GOVERNMENT STREET |
| City | BRANDON |
| State | MS |
| Zip Code | 39042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740821529 | Claudia Francis Jones | Technician | 1008 Greenfield Circle, Brandon, MS 39042 | 2019-10-03 |
| 1194294546 | Allen Keith Johnson Jr. | Counselor | 1700 West Government Street Building B. Suite O., Brandon, MS 39042 | 2018-11-15 |
| 1689167462 | Regional Home Care and Infusions, Inc. | Registered Nurse | 302 Town Square, Suite 110, Brandon, MS 39042 | 2018-06-07 |
| 1013419563 | Brandon Family Chiropractic LLC | Chiropractor | 1350 West Government Street Suite A1, Brandon, MS 39042 | 2018-03-01 |
| 1184146789 | Lakeland Home Program LLC | Clinic/Center | 209 Mar Lyn Dr, Brandon, MS 39042 | 2017-07-14 |
| 1104275510 | Matthew Logue | Community Health Worker | 2009 Mossy Cove, Brandon, MS 39042 | 2016-06-07 |
| 1932569704 | Haley Wilson | Chiropractor | 1350 W Government St Ste A1, Brandon, MS 39042 | 2016-03-07 |
| 1760825434 | Linda J. Bridges | Respiratory Therapist, Certified | 330 Rankin Road, Brandon, UNITED STATES 39042 | 2013-04-12 |
| 1861739922 | Georgia Christine Shirley | Nurse Practitioner | 2008 Brookstone Place, Brandon, MS 39042 | 2013-01-09 |
| 1881943900 | Kennedy Chiropractic Clinic Inc | Chiropractor | 393 Crossgates Blvd, Suite B, Brandon, MS 39042 | 2012-09-05 |
| Find all providers in zip 39042 | ||||
| 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 |
|---|---|---|---|---|
| 1952900581 | Maegan Cook Bridges | Family Medicine | 312 Ridge Pointe Dr, Brandon, MS 39042-5035 | 2020-10-24 |
| 1346887353 | Kelli Marie Foster | Family Medicine | 515 Belle Oak Pl, Brandon, MS 39042-8111 | 2019-12-09 |
| 1649764127 | Specialty Diagnostics LLC | Family Medicine | 1149 Old Fannin Rd Ste 22, Brandon, MS 39047 | 2018-06-19 |
| 1033566161 | Medi Brandon LLC | Family Medicine | 203 W Bloomingdale Ave, Brandon, FL 33511-7404 | 2016-05-18 |
| 1144659178 | Medical Foundation of Central Ms, Inc | Family Medicine | 1887 Spillway Rd., Brandon, MS 39047 | 2013-11-12 |
| 1457780637 | Jennifer Packing-ebuen | Family Medicine | 426w Brandon Blvd, Brandon, FL 33511-5002 | 2013-11-07 |
| 1265780910 | Uc1, LLC | Family Medicine | 799 Lumsden Rd, Brandon, FL 33511 | 2012-08-28 |
| 1992082721 | Mathew Medical Consulting Pa | Family Medicine | 635 Tuscanny St, Brandon, FL 33511-6165 | 2011-11-08 |
| 1003192246 | Sandra Dorsey | Family Medicine | 122 South Moon Avenue, Brandon, FL 33511 | 2011-11-02 |
| 1952604811 | First Intermed Corporation | Family Medicine | 106 Lake Vista Place, Brandon, MS 39047-0000 | 2010-12-15 |
| Find all providers in BRANDON | ||||
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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.