NPIMap

Individual provider Active NPI

Jonathan Lee

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1174904361
Registry record updated Oct 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
T-2979 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 984-6800
NPI assigned
Jun 12, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X T-2979 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-6800

Other identifiers 1

IdentifierTypeStateIssuer
02832791MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181004002901 MS Practitioner - Family Practice 2365758372 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Systems Management, LLCGroup PAC ID 5092964643, 49 clinicians
Quad Intermed Company LLCGroup PAC ID 6709245954, 42 clinicians

Practice addresses (Care Compare)

129 Ctr St
Suite B
Richland, MS 39218-4800
Phone (769) 233-7141

1515 Jefferson St
Laurel, MS 39440-4244
Phone (601) 425-4893

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Flowood, MS, CCN 257126
  • St Joseph Hospice of West Mississippi, LLC Hospice, Richland, MS, CCN 251575
  • St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048
  • Baptist Medical Center-Yazoo Hospital, Yazoo City, MS, CCN 251313
  • Yazoo City Rehabilitation and Healthcare Center Nursing home, Yazoo City, MS, CCN 255146

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Quad Intermed Company LLC Current Accepting new patients
Quad Intermed Company LLC CurrentSince Oct 21, 2023 Accepting new patients
Quad Intermed Company LLC CurrentSince Oct 21, 2023 Accepting new patients
Nexion Health at Yazoo City, Inc. Past Accepting new patients

Locations

1515 Jefferson St
Laurel, MS 39440
Phone (601) 425-4893

342 Gilchrist Dr
Pearl, MS 39208
Phone (601) 939-0700

308 Corporate Dr
Ridgeland, MS 39157
Phone (601) 898-7500

4204 Clay St
#V
Vicksburg, MS 39183
Phone (601) 619-7717

4204 Clay St
Vicksburg, MS 39183
Phone (601) 200-4560

Interoperability endpoints

  • Direct secure messaging: jlee2546075@direct.casso.us.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Joseph Hospice of West Mississippi LLCRichland, MS, CCN 251575 Hospice Contracted Managing Employee May 23, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445817600000",
    "number": "1174904361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JONATHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-12",
        "last_updated": "2015-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "T-2979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02832791",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.