NPIMap

Organization Active NPI

Central Jackson Family Medical Clinic

  • Medical Specialty Clinic/Center
  • Jackson, MS
National Provider Identifier
1154549707
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
13653 Issued in MS
Legal business name
CENTRAL JACKSON FAMILY MEDICAL CLINIC
Practice address
514 C Woodrow Wilson
Jackson, MS 39216
Phone
(601) 981-7198
Fax
(601) 981-6616
NPI assigned
Apr 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
Dr. Cassandra Faye Thomas, M.D.NPI 1033299896
Title
Physicain
Phone
(601) 981-7198

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 13653 MS Primary
Medical Specialty Clinic/Center 261QM2500X 18905 MS

Addresses

Primary practice location

514 C Woodrow Wilson
Jackson, MS 39216

Mailing address

P.O. Box 4610
Jackson, MS 39296-4610
Phone (601) 981-7198

Other identifiers 2

IdentifierTypeStateIssuer
00937242MedicaidMS
00112137MedicaidMS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1154549707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4610",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392964610",
            "telephone_number": "601-981-7198",
            "fax_number": "601-981-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 C WOODROW WILSON",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-981-7198",
            "fax_number": "601-981-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL JACKSON FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_middle_name": "FAYE",
        "authorized_official_title_or_position": "PHYSICAIN",
        "authorized_official_telephone_number": "601-981-7198",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MS",
            "license": "13653",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MS",
            "license": "18905",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00937242",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00112137",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 9, 2010; 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.