ST DOMINIC-JACKSON MEMORIAL HOSPITAL (NPI# 1679596860) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679596860 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC-JACKSON MEMORIAL HOSPITAL |
| Practice Address |
969 Lakeland Dr Jackson MS 39216-4606 |
| Practice Telephone | 6012002000 |
| Practice Fax Number | 6002000924 |
| Mailing Telephone | 6012002000 |
| Mailing Fax Number | 6002000924 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. PETER G. KOURY (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 6012006950 |
| Authorized Official Credential | CPA, FHFMA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273R00000X | Psychiatric Unit | 14-031 | MS | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00020034 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306876065 | St Dominic-jackson Memorial Hospital | General Acute Care Hospital | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2006-07-05 |
| Street Address |
969 LAKELAND DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306843131 | Joseph N Candelora | Pathology | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2005-07-07 |
| 1316554736 | Brooke Collins | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-09-29 | |
| 1972117232 | William Paul Coe | Nurse Practitioner | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-09-03 |
| 1376157099 | Kathryn Taylor Parvin | Radiology | 969 Lakeland Dr, Jackson, MS 39216-4699 | 2020-09-01 |
| 1235741646 | Stephanie H Atkins | Student in an Organized Health Care Education/Training Program | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-08-18 |
| 1063038636 | Ayanna Washington | Registered Nurse | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-06-19 |
| 1669092227 | Christopher L Stephens | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-04-23 |
| 1578190385 | Lindsey Elizabeth Jibol | Counselor | 969 Lakeland Dr, Jackson, MS 39216-4699 | 2020-03-24 |
| 1801436951 | Callie Bridges | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-01-07 |
| 1053951194 | Zachary Halliwell | Nurse Anesthetist, Certified Registered | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-01-07 |
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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 | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962594317 | W.a. Foote Memorial Hospital, Inc. | Psychiatric Unit | 205 N East Ave, 7th Fl One Jackson Square, Jackson, MI 49201 | 2006-09-29 |
| 1417984360 | Mississippi Baptist Medical Center, Inc. | Psychiatric Unit | 1225 N State St, Jackson, MS 39202-2064 | 2006-06-27 |
| 1912945775 | Jackson Hma LLC | Psychiatric Unit | 1850 Chadwick Dr, Jackson, MS 39204-3404 | 2006-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407269756 | East Mississippi State Hospital | Psychiatric Unit | 1401 College Dr, Meridian, MS 39307-5345 | 2014-06-04 |
| 1699803395 | Walter Robert Jones Jr. | Psychiatric Unit | Hwy 468, Hudspeth Regional Center, Whitfield, MS 39193 | 2007-03-02 |
| 1740228881 | Vicksburg Healthcare LLC | Psychiatric Unit | 1111 N Frontage Rd, Vicksburg, MS 39180-5102 | 2006-06-02 |
| 1306803481 | George County Hospital | Psychiatric Unit | 859 Winter Steet, Lucedale, MS 39452-6603 | 2006-05-01 |
| 1457330995 | South Mississippi State Hospital | Psychiatric Unit | 823 Highway 589, Purvis, MS 39475-4194 | 2006-01-12 |
| 1831184951 | Alliance Health Center Inc | Psychiatric Unit | 5000 Highway 39 N, Meridian, MS 39301-1021 | 2005-09-14 |
| 1801414115 | Singing River Gulfport | Psychiatric Unit | 15200 Community Rd, Gulfport, MS 39503-3085 | 2020-07-13 |
| 1679036313 | Progressive Medical Management of Batesville LLC | Psychiatric Unit | 155 Keating Rd, Batesville, MS 38606-2901 | 2019-04-10 |
| 1689191629 | Boa Vida Hospital of Aberdeen, Ms, LLC | Psychiatric Unit | 400 S Chestnut St, Aberdeen, MS 39730-3335 | 2017-08-29 |
| 1033643937 | Batesville Regional Medical Center, Inc. | Psychiatric Unit | 303 Medical Center Dr, Batesville, MS 38606-8608 | 2017-04-18 |
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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.