NPIMap

Organization Active NPI

Northstar Anesthesia of Mississippi, LLC

  • Anesthesiology Physician
  • Natchez, MS
National Provider Identifier
1124415567
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
NORTHSTAR ANESTHESIA OF MISSISSIPPI, LLC
Practice address
54 Sergeant Prentiss Dr
Natchez, MS 39120-4726
Phone
(601) 443-2100
NPI assigned
Apr 23, 2015
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Joshua Lumbley, MD
Title
President
Phone
(214) 687-0001

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 367500000X

Addresses

Primary practice location

54 Sergeant Prentiss Dr
Natchez, MS 39120-4726

Mailing address

PO Box 610506
Dallas, TX 75261-0506
Phone (239) 610-0775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150624002329 MS Part B Supplier - Clinic/Group Practice 1658682117 Receives reassigned benefits from 63 practitioners
Practice locations: Vicksburg, MS

National Provider Directory

National Provider Directory

Locations

54 Sgt Prentiss Dr
Natchez, MS 39120
Phone (601) 443-2100

Practitioners & affiliated clinicians

Practitioners 64

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.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1124415567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610506",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752610506",
            "telephone_number": "239-610-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 SERGEANT PRENTISS DR",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391204726",
            "telephone_number": "601-443-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR ANESTHESIA OF MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "LUMBLEY",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-687-0001",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Natchez, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.