NPIMap

Organization Active NPI

St. Dominic Medical Associates LLC

Doing business as Internal Medicine Group

  • Internal Medicine Physician
  • Jackson, MS
National Provider Identifier
1124252788
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ST. DOMINIC MEDICAL ASSOCIATES LLC
Doing business as
Internal Medicine Group
Practice address
971 Lakeland Dr
Suite 250
Jackson, MS 39216-4643
Phone
(601) 982-1283
NPI assigned
May 12, 2009
Last updated
Jul 22, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. DOMINIC JACKSON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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

Authorized official

Name
Danielle Stuart
Title
Credentialing Specialist
Phone
(601) 200-4880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MS Primary

Addresses

Primary practice location

971 Lakeland Dr
Suite 250
Jackson, MS 39216-4643

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-5986

Other practice location 1

106 Highland Way Ste 200
Madison, MS 39110-6933
Phone (601) 200-4141

Other practice location 2

970 Lakeland Dr Ste 43
Jackson, MS 39216-4634
Phone (601) 200-4850

Other practice location 3

106 Lake Vista Pl
Brandon, MS 39047-6384
Phone (601) 919-2924

Other practice location 4

970 Lakeland Dr Ste 40
Jackson, MS 39216-4640
Phone (601) 200-4850

Other names 1

  • Internal Medicine 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
Jackson Mental Health

Other organizations with this tax ID 27

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

View all 27

Locations

106 Highland Way
Ste 200
Madison, MS 39110
Phone (601) 200-4141

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1242086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563753600000",
    "number": "1124252788",
    "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": "601-200-5986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR",
            "address_2": "SUITE 250",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164643",
            "telephone_number": "601-982-1283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Highland Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391106933",
            "country_code": "US",
            "telephone_number": "601-200-4141",
            "fax_number": "601-200-4150",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "970 Lakeland Dr Ste 43",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164634",
            "country_code": "US",
            "telephone_number": "601-200-4850",
            "fax_number": "601-200-4838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "106 Lake Vista Pl",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "MS",
            "postal_code": "390476384",
            "country_code": "US",
            "telephone_number": "601-919-2924",
            "fax_number": "601-992-7347",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "970 Lakeland Dr Ste 40",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164640",
            "country_code": "US",
            "telephone_number": "601-200-4850",
            "fax_number": "601-200-4838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. DOMINIC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. DOMINIC JACKSON MEMORIAL HOSPITAL",
        "enumeration_date": "2009-05-12",
        "last_updated": "2019-07-22",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "601-200-4880"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internal Medicine Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Internal Medicine 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 Jul 22, 2019; 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.