NPIMap

Organization Active NPI

St Dominic Medical Associates

  • Infectious Disease Physician
  • Jackson, MS
National Provider Identifier
1114205010
Registry record updated Jun 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
ST DOMINIC MEDICAL ASSOCIATES
Practice address
971 Lakeland Dr Ste 954
Jackson, MS 39216-4609
Phone
(601) 200-4714
Fax
(601) 200-4718
NPI assigned
Jul 26, 2011
Organization subpart
Yes
Parent organization
ST DOMINIC JACKSON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2016

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

Authorized official

Name
Jennifer Sinclair
Title
VP of Finance
Phone
(601) 200-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

971 Lakeland Dr Ste 954
Jackson, MS 39216-4609

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4749

Other identifiers 1

IdentifierTypeStateIssuer
02122371MedicaidMS

Other names 1

  • St Dominic Infectious Disease Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Dominic Medical Associates LLC28 organizations share this tax ID, including this one
Part of
Chemical Dependency Uni

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1114205010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 954",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164609",
            "telephone_number": "601-200-4714",
            "fax_number": "601-200-4718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST DOMINIC MEDICAL ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST DOMINIC JACKSON MEMORIAL HOSPITAL",
        "enumeration_date": "2011-07-26",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "SINCLAIR",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "601-200-2000"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02122371",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Dominic Infectious Disease Group",
            "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 Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.