ST DOMINIC MEDICAL ASSOCIATES (NPI# 1669742417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669742417 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC MEDICAL ASSOCIATES |
| Other Organization Name | MARTIN SURGICAL ASSOCIATES |
| Practice Address |
971 Lakeland Dr Jackson MS 39216-4643 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6019879007 |
| Practice Fax Number | 6019879190 |
| Mailing Telephone | 6012004749 |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-02-02 |
| Authorized Official Name | JENNIFER SINCLAIR (VP OF FINANCE) |
| 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 | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Martin Surgical Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346510559 | St Dominic Medical Associates | Obstetrics & Gynecology | 971 Lakeland Dr, Suite 750, Jackson, MS 39216-4643 | 2012-01-04 |
| 1114205010 | St Dominic Medical Associates | Internal Medicine | 971 Lakeland Dr Ste 954, Jackson, MS 39216-4609 | 2011-07-26 |
| 1194010850 | St Dominic Medical Associates | Family Medicine | 950 Highway 80 E, Clinton, MS 39056-5203 | 2011-06-10 |
| 1972892321 | St Dominic Medical Associates | Family Medicine | 127 Grandview Blvd, Madison, MS 39110-7595 | 2011-04-06 |
| 1033413174 | St Dominic Medical Associates | Family Medicine | 5520 Highway 80 E, Pearl, MS 39208-8926 | 2011-01-04 |
| Street Address |
971 LAKELAND DR |
| 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 | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851731103 | Zachary James Virgin | Surgery | 300 W Washington Ave Ste 300, Jackson, MI 49201-2160 | 2013-07-01 |
| 1407290372 | Derek S. Palmer | Surgery | 120 District Blvd Apt 433, Jackson, MS 39211-6389 | 2013-04-23 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1639419997 | Fred Silvestri Md, LLC | Surgery | 4 Long Bay Rd, Jackson, NJ 08527-2662 | 2013-02-25 |
| 1528356482 | James P. Spell | Surgery | 21 Lamplighter Rd., Jackson, MS 39208 | 2011-07-13 |
| 1629371018 | Richard L Yelverton Md Pa | Surgery | 1040 River Oaks Dr Ste 102, Jackson, MS 39232-9539 | 2010-12-07 |
| 1619125952 | Otha Edward Williams Jr. | Surgery | 1736 Lake Trace Dr, Jackson, MS 39211-3353 | 2008-08-28 |
| 1770604803 | Rajesh Kuruba | Surgery | 1500 E Woodrow Wilson Ave., Jackson, MS 39216-5199 | 2007-04-03 |
| 1679692396 | Reginald Willis Martin | Surgery | 971 Lakeland Dr Ste 211, Jackson, MS 39216-4607 | 2007-03-28 |
| 1295878783 | P George Poore | Surgery | 555 East Broadway Ste 212, Jackson, WY 83001-4777 | 2007-02-14 |
| 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.