Individual provider Active NPI

Clinton Walker

  • Family Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1124417761
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R886071 Issued in MS
Practice address
2500 North State Street
Jackson, MS 39216-4500
Phone
(601) 815-4778
Fax
(601) 984-5420
NPI assigned
Jan 20, 2015
Last updated
Oct 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R886071 MS Primary

Addresses

Primary practice location

2500 North State Street
Jackson, MS 39216-4500

Mailing address

2500 North State Street
Jackson, MS 39216-4500
Phone (601) 815-4778

Other identifiers 1

IdentifierTypeStateIssuer
04706763MedicaidMS

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150310000938 MS Practitioner - Nurse Practitioner 7719203769 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Corner Clinic Urgent Care LLC Family CurrentSince Nov 17, 2022 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Aug 16, 2016 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Aug 16, 2016 Accepting new patients
McFatter Family Medical, LLC CurrentSince Oct 1, 2021 Accepting new patients

Locations

225 Bank First Dr
Flowood, MS 39232
Phone (601) 992-0004

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

2500 N State St
Rm 2525
Jackson, MS 39216
Phone (601) 984-1530

Interoperability endpoints

  • Direct secure messaging: clinton.walker@sdma.eclinicaldirectplus.com
  • Direct secure messaging: cwalker70149@ummc.direct-ci.com

Organizations & group practices 4

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": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1124417761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-4778",
            "fax_number": "601-984-5420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-4778",
            "fax_number": "601-984-5420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "CLINTON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-20",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R886071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04706763",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.