Individual provider Active NPI

Sarah Kay Fountain

  • Family Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1063122612
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
905690 Issued in MS
Practice address
970 Lakeland Dr Ste 61
Jackson, MS 39216-4634
Phone
(601) 982-7850
NPI assigned
Dec 5, 2022
Last updated
Sep 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 905690 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) 405-3690

Other names 1

  • Sarah Kay Dickerson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230221003354 MS Practitioner - Nurse Practitioner 7618340605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

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

Merit-based Incentive Payment System (MIPS)

Final score
88.07 of 100Reported as apm
Quality
73.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
905690MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Heart Clinic. P.a. CurrentSince Sep 3, 2024 Accepting new patients

Locations

970 Lakeland Dr
Ste 61
Jackson, MS 39216
Phone (601) 200-2780

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: sarah.fountainnp.p1@direct.jacksonheart.nextgenshare.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1670198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1063122612",
    "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": "601-405-3690"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOUNTAIN",
        "first_name": "SARAH",
        "middle_name": "KAY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-05",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "905690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARAH",
            "last_name": "DICKERSON",
            "middle_name": "KAY",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.