John Elgin Wilkaitis, M.D.,M.B.A., M.S.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

17435 Issued in MS

Practice address

4500 Interstate 55 Frontage Road N
Suite 234
Jackson, MS 39211-5931

Phone

(601) 982-8531

Fax

(888) 735-7202

NPI assigned

Jun 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

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

Specialty

Psychiatry

Education

University of Mississippi School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alliance Health Center IncGroup PAC ID 1355366113, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine, Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alliance Health Center Inc.

  • Psychiatry Physician
  • Meridian, MS
  • NPI 1679850150
  Medicare reassignment Care Compare group NPD
• Children's Psychiatric Clinic

  • Child & Adolescent Psychiatry Physician
  • Flowood, MS
  • NPI 1891136818
  NPD Authorized official
• John Elgin Wilkaitis, MD, Ms, PLLC

  dba Children's Psychiatric Solutions

  • Adolescent and Children Mental Health Clinic/Center
  • Jackson, MS
  • NPI 1518411529
  NPD Authorized official
• Clinical Neuroscience Group, PLLC

  • Psychiatry Physician
  • Flowood, MS
  • NPI 1710175260
  NPD (past) Authorized official
• Alliance Health Center Inc

  • Psychiatric Hospital
  • Meridian, MS
  • NPI 1831184951
  NPD (past)
• Brentwood Acquisition Inc

  • Psychiatric Hospital
  • Flowood, MS
  • NPI 1487638441
  NPD (past)
• Garden Park

  dba Region VI Mental Health/Mental Retardation Commission

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greenwood, MS
  • NPI 1932437209
  NPD (past)
• Poplar Bluff Hma Physician Management, LLC

  • Family Medicine Physician
  • Poplar Bluff, MO
  • NPI 1598710147

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1154360824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 GRANDVIEW CIR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390477398",
            "telephone_number": "601-829-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 INTERSTATE 55 FRONTAGE ROAD N",
            "address_2": "SUITE 234",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392115931",
            "telephone_number": "601-982-8531",
            "fax_number": "888-735-7202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3531 Lakeland Dr Ste 1052",
            "address_purpose": "LOCATION",
            "city": "Flowood",
            "state": "MS",
            "postal_code": "392328016",
            "country_code": "US",
            "telephone_number": "601-936-2024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKAITIS",
        "first_name": "JOHN",
        "middle_name": "ELGIN",
        "name_prefix": "Dr.",
        "credential": "M.D.,M.B.A., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "17435",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "2005021711",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MS",
            "license": "17435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03932074",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207430414",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "$$$$$$$$$",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melora Wiley, M.D.
• Thomas L Wiley, MD
• Zachary Wiley
• Andrew Mark Wilhelm, D.O.
• Chelle P Wilhelm, M.D.
• Bobby S Wilkerson, M.D.
• Cynathia Wilkerson
• Parker Ames Wilkerson
• Leila McReynolds Wilkins, CRNA
• Marquita F Wilkins

• Child & Adolescent Psychiatry Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Child & Adolescent Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.