NPIMap

Organization Active NPI

St. Dominic Medical Associates LLC

  • Neurological Surgery Physician
  • Jackson, MS
National Provider Identifier
1174686182
Registry record updated Jun 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
ST. DOMINIC MEDICAL ASSOCIATES LLC
Practice address
971 Lakeland Dr. Suite 1250
Jackson, MS 39216-0000
Phone
(601) 200-5955
Fax
(601) 200-5943
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2016

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

Authorized official

Name
Jennifer Sinclair
Title
President of Sdma
Phone
(601) 200-6955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

971 Lakeland Dr. Suite 1250
Jackson, MS 39216-0000

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4749

Other identifiers 1

IdentifierTypeStateIssuer
01600341MedicaidMS

Other names 1

  • Neurosurgery Associates 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

Other organizations with this tax ID 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1174686182",
    "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": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR. SUITE 1250",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392160000",
            "telephone_number": "601-200-5955",
            "fax_number": "601-200-5943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. DOMINIC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "SINCLAIR",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT OF SDMA",
        "authorized_official_telephone_number": "601-200-6955"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01600341",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurosurgery Associates",
            "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 Jun 28, 2016; 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.