Active NPI
Quad Intermed Company LLC
- Clinic/Center
- Jackson, MS
National Provider Identifier
1013790294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- QUAD INTERMED COMPANY LLC
- Practice address
- 5005 Old Canton Rd
Jackson, MS 39211-5421 - Phone
- (601) 957-3333
- NPI assigned
- Aug 14, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- William M Grantham, MD
- Title
- Ceo
- Phone
- (601) 898-7530
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
5005 Old Canton Rd
Jackson, MS 39211-5421
Mailing address
308 Corporate Dr
Ridgeland, MS 39157-8803
Other names 1
- MEA Medical Clinics
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230706000437 | MS | Part B Supplier - Clinic/Group Practice | 6709245954 |
Receives reassigned benefits from 50 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Pearl, MS; Brandon, MS; Yazoo City, MS; Vicksburg, MS; Ridgeland, MS; Richland, MS; Madison, MS; Laurel, MS… |
Other NPIs on the same Medicare enrollment 16
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Endocrinology, Diabetes & Metabolism Physician
- Madison, MS
- NPI 1750254819
O20230706000437
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691971200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1691971200000",
"number": "1013790294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 CORPORATE DR",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391578803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5005 OLD CANTON RD",
"city": "JACKSON",
"state": "MS",
"postal_code": "392115421",
"telephone_number": "601-957-3333"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "QUAD INTERMED COMPANY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-08-14",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A",
"authorized_official_last_name": "GRANTHAM",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "601-898-7530",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "MEA Medical Clinics",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.