NPIMap

Individual provider Active NPI

Amber Goodman, PA-C

  • Physician Assistant
  • Jackson, MS
National Provider Identifier
1013305895
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00345 Issued in MS
Practice address
970 Lakeland Dr Ste 61
Jackson, MS 39216-4634
Phone
(601) 982-7850
Fax
(601) 366-8507
NPI assigned
Jan 2, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00345 MS Primary

Addresses

Primary practice location

970 Lakeland Dr Ste 61
Jackson, MS 39216-4634

Mailing address

970 Lakeland Dr Ste 61
Jackson, MS 39216-4634
Phone (601) 982-7850

Other practice location 1

3800 I-55 N Frontage Rd Ste 102
Jackson, MS 39212
Phone (601) 200-6872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171030002038 MS Practitioner - Physician Assistant 9537489109 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kings Daughters Medical CenterGroup PAC ID 3072575539, 75 clinicians
Jackson Heart Clinic. P.a.Group PAC ID 0547204091, 40 clinicians

Practice addresses (Care Compare)

427 Hwy 51 N
Brookhaven, MS 39601-2350
Phone (601) 833-6011

970 Lakeland Dr
Suite 61
Jackson, MS 39216-4634
Phone (601) 982-7850

Hospital & facility affiliations

  • King'S Daughters Medical Center-Brookhaven Hospital, Brookhaven, MS, CCN 250057
  • St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
86.07 of 100Reported as group
Quality
74.67
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00345MSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Dominic Medical Associates LLC CurrentSince Nov 4, 2023 Accepting new patients
King'S Daughters Medical Center CurrentSince Jul 1, 2025 Accepting new patients
King'S Daughters Medical Center CurrentSince Jul 1, 2025 Accepting new patients
St. Dominic Jackson Memorial Past Accepting new patients
St Dominic Medical Associates LLC Past Accepting new patients
KDMC Physician Clinics LLC Past Accepting new patients

Locations

1014 D a Biglane Dr
Brookhaven, MS 39601
Phone (601) 823-5275

427 Highway 51 N
Brookhaven, MS 39601
Phone (601) 833-6011

969 Lakeland Dr
Jackson, MS 39216
Phone (601) 200-4644

Interoperability endpoints

  • Direct secure messaging: amber.goodman.p1@direct.jacksonheart.nextgenshare.com
  • FHIR API: https://api.platform.athenahealth.com/6393/brand/1/csg/41/fhir/r4

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1013305895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 LAKELAND DR STE 61",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164634",
            "telephone_number": "601-982-7850",
            "fax_number": "601-366-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 LAKELAND DR STE 61",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164634",
            "telephone_number": "601-982-7850",
            "fax_number": "601-366-8507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 I-55 N Frontage Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "39212",
            "country_code": "US",
            "telephone_number": "601-200-6872",
            "fax_number": "601-200-6805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "AMBER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-02",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA00345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.