Individual provider Active NPI

Candace Thompson

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1093375511
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
29692 Issued in MS
Practice address
1500 E Woodrow Wilson Ave # 39216
Jackson, MS 39216-5116
Phone
(601) 362-4471
NPI assigned
Jun 17, 2019
Last updated
Sep 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 29692 MS Primary

Addresses

Primary practice location

1500 E Woodrow Wilson Ave # 39216
Jackson, MS 39216-5116

Mailing address

1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220812001730 MS Practitioner - Family Practice 5698104453 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Meharry Medical College School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

764 Lakeland Dr
2ND
Jackson, MS 39216-4651
Phone (601) 815-2005

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 28, 2024 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 28, 2024 Accepting new patients
Quinn Healthcare,PLLC Family Medicine CurrentSince Aug 1, 2022 Accepting new patients

Locations

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

764 Lakeland Dr
Fl 2
Jackson, MS 39216
Phone (601) 984-6800

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

768 Avery Blvd N
Ridgeland, MS 39157
Phone (601) 487-6482

Networks

  • LA PPO C-SNP

Organizations & group practices 3

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 1

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": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1093375511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON AVE # 39216",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165116",
            "telephone_number": "601-362-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "CANDACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "29692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.