NPIMap

Individual provider Active NPI

Jessica Anne Lauderdale, DO

  • Family Medicine Physician
  • Pontotoc, MS
National Provider Identifier
1093095523
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
23832 Issued in MS
Practice address
11 E Jefferson St
Pontotoc, MS 38863-2807
Phone
(662) 489-6041
NPI assigned
Aug 29, 2011
Last updated
Nov 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 23832 MS Primary
General Practice Physician 208D00000X L2069591 MI

Addresses

Primary practice location

11 E Jefferson St
Pontotoc, MS 38863-2807

Mailing address

11 E Jefferson St
Pontotoc, MS 38863-2807
Phone (662) 489-6041

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
I20170111000566 MS Practitioner - Family Practice 4082901228 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

11 E Jefferson St
Pontotoc, MS 38863-2807
Phone (662) 489-6041

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.39 of 100Reported as group
Quality
65.98
Improvement activities
40
Cost
74.48

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
23832MSMDFamily Medicine Physician
L2069591MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Medicine Associates LLC Family Medicine CurrentSince Dec 4, 2023 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms LLC CurrentSince Oct 1, 2017 Accepting new patients
Lauderdale Medical Group PLLC CurrentSince Jan 1, 2024 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC CurrentSince Oct 1, 2017 Accepting new patients
Chris Park DO PC Family Medicine CurrentSince Nov 19, 2023 Accepting new patients

Locations

400 S Chestnut St
Aberdeen, MS 39730
Phone (662) 369-2455

40128 Hamilton Rd
Hamilton, MS 39746
Phone (662) 343-5129

200 State Highway 30 W
New Albany, MS 38652
Phone (601) 534-7631

11 E Jefferson St
Pontotoc, MS 38863
Phone (662) 489-6041

Interoperability endpoints

  • Direct secure messaging: jessica.lauderdale.1@30165.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1093095523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 E JEFFERSON ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388632807",
            "telephone_number": "662-489-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 E JEFFERSON ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388632807",
            "telephone_number": "662-489-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUDERDALE",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-29",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "23832",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "L2069591",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontotoc, MS

Sources for this page

Verify at the official NPI Registry.