ST DOMINIC MEDICAL ASSOCIATES LLC (NPI# 1831342054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831342054 |
| Entity Type | Organization |
| Organization Name | ST DOMINIC MEDICAL ASSOCIATES LLC |
| Other Organization Name | CARDIOVASCULAR SURGERY ASSOCIATES |
| Practice Address |
970 Lakeland Dr Ste 61 Jackson MS 39216-4634 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 6012002780 |
| Practice Fax Number | 6012002788 |
| Mailing Telephone | 6012004749 |
| Mailing Fax Number | 6012005929 |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2019-10-28 |
| Authorized Official Name | DANIELLE STUART (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 6012004880 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. DOMINIC JACKSON MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00978789 | 05 |
| Other Name | Type Code |
|---|---|
| Cardiovascular Surgery Associates | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 332 Highway 12 W, Kosciusko, MS 390903209 | 6012002780 | 6012002788 |
| 360 Simpson Highway 149 Ste 370, Magee, MS 391113843 | 6012002780 | 6012002788 |
| 4204 Clay St, Vicksburg, MS 391833438 | 6012002780 | 6012002788 |
| 610 Second St, Pelahatchie, MS 391453135 | 6018545044 | 6018548448 |
| 810 E Sunflower Rd Ste 100j, Cleveland, MS 387322828 | 6012002780 | 6012002788 |
| 971 Lakeland Dr Ste 657, Jackson, MS 392164608 | 6012002990 | 6012005939 |
| 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 |
| 1124452859 | St Dominic Medical Associates LLC | Pain Medicine | 970 Lakeland Dr, Suite 45, Jackson, MS 39216-4635 | 2013-08-29 |
| Street Address |
970 LAKELAND DR STE 61 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861590457 | Sandra Speckels Mccearley | Internal Medicine | 970 Lakeland Dr Ste 61, Jackson, MS 39216 | 2006-09-20 |
| 1225671456 | Joshua Ledford | Nurse Practitioner | 970 Lakeland Dr Ste 61, Jackson, MS 39216-4682 | 2019-10-21 |
| 1922546589 | Amy Elizabeth Valentine | Nurse Practitioner | 970 Lakeland Dr Ste 61, Jackson, MS 39216-4634 | 2017-02-03 |
| 1518417856 | Kristen Carroll Mccoy | Nurse Practitioner | 970 Lakeland Dr Ste 61, Jackson, MS 39216-4682 | 2016-10-11 |
| 1831532746 | Jing-yuan Ma | Internal Medicine | 970 Lakeland Dr Ste 61, Jackson, MS 39216 | 2013-04-10 |
| 1376858761 | Mindy Jo Edna Byrd | Nurse Practitioner | 970 Lakeland Dr Ste 61, Jackson, MS 39216-4634 | 2010-08-10 |
| 1891926754 | Elizabeth Michelle Ward | Nurse Practitioner | 970 Lakeland Dr Ste 61, Jackson, MS 39216-4634 | 2009-07-27 |
| 1821290990 | Donny R. Stokes | Internal Medicine | 970 Lakeland Dr Ste 61, Jackson, MS 39216-4634 | 2007-06-01 |
| 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 | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720258734 | Jacob Jerome Cohen | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 63 Colchester Dr, Jackson, NJ 08527-4782 | 2008-03-05 |
| 1841498656 | Kenneth Marc Begelman | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 400 Moulton Loop, Jackson, WY 83001-0764 | 2007-07-03 |
| 1275581720 | Douglas C. Appleby Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 329 Coatsland Dr, Jackson, TN 38301-3912 | 2006-05-05 |
| 1639176472 | Vern Antoine Keller | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 971 Lakeland Dr Ste 657, Jackson, MS 39216-4608 | 2005-07-07 |
| 1942740311 | W. A. Foote Memorial Hospital, Inc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 205 N East Ave, Jackson, MI 49201-1753 | 2017-03-03 |
| 1134462849 | Ali Dodge-khatami | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2500 N State St, Division of Pediatric Cardiac Surgery, Jackson, MS 39216-4500 | 2013-04-01 |
| 1306077672 | Robert B Lee Md Pllc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1860 Chadwick Dr, Suite 352, Jackson, MS 39204-3463 | 2009-08-04 |
| 1538396056 | St. Dominic Medical Associates Inc | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 971 Lakeland Dr, Suite 1159, Jackson, MS 39216-4643 | 2009-06-11 |
| 1972743797 | Jacob Moremen | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2500 North State Street, Jackson, MS 39216-4500 | 2009-03-06 |
| 1598947145 | Thomas L Kilgore | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1225 N State St, Jackson, MS 39202-2064 | 2007-12-05 |
| 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.