NPIMap

Individual provider Active NPI

Joseph W Blackston, MD

  • Internal Medicine Physician
  • Jackson, MS
National Provider Identifier
1194834747
Registry record updated Sep 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD 11335 Issued in MS
Practice address
1900 Petit Bois St N
Jackson, MS 39211-6707
Phone
(601) 981-4625
Fax
(601) 981-4625
NPI assigned
Aug 29, 2006
Last updated
Sep 11, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2007

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11335 MS
Internal Medicine Physician 207R00000X MD 11335 MS Primary
Legal Medicine (M.D./D.O.) Physician 209800000X MD 11335 MS

Addresses

Primary practice location

1900 Petit Bois St N
Jackson, MS 39211-6707

Mailing address

1900 Petit Bois St N
Jackson, MS 39211-6707
Phone (601) 981-4625

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
I20061006000601 MS Practitioner - Family PracticePractitioner - Internal MedicinePractitioner - Emergency Medicine 1658377064 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Associates of Vicksburg PLLCGroup PAC ID 3577782366, 8 clinicians
Central Mississippi Medical Clinic PLLCGroup PAC ID 5991298036, 2 clinicians

Practice addresses (Care Compare)

2080 S Frontage Rd
Suite 100
Vicksburg, MS 39180-5883
Phone (601) 262-1000

2200 Hwy 61 N
Suite 2100
Vicksburg, MS 39183-8246
Phone (601) 628-0022

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11335MSMDEmergency Medicine Physician
MD 11335MSMDLegal Medicine (M.D./D.O.) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Services of Meridian, Inc. Emergency Medicine CurrentSince Mar 15, 2019 Accepting new patients
Keystone Medical Services of Ms, Inc Emergency Medicine CurrentSince Jan 16, 2013 Accepting new patients
Central Mississippi Medical Clinic PLLC Internal Medicine CurrentSince Nov 4, 2025 Accepting new patients
Vicksburg Hma Physician Management LLC Internal Medicine Current Accepting new patients
Medical Associates of Vicksburg PLLC Internal Medicine CurrentSince Jul 1, 2021 Accepting new patients
App of Mississippi Ed, LLC Emergency Medicine CurrentSince May 15, 2018 Accepting new patients
University Internal Medicine Assoc LLP Internal Medicine Past Accepting new patients
Vicksburg Healthcare LLC Past Accepting new patients
Howcott Emergency Physicians Emergency Medicine Past Accepting new patients
Lefleur Emergency Physicians Emergency Medicine Past Accepting new patients
Sterling Emergency Services of Mississippi, Inc Emergency Medicine Past Accepting new patients

Locations

150 Reynoir St
Biloxi, MS 39530
Phone (228) 284-2389

350 Crossgates Blvd
Brandon, MS 39042
Phone (601) 824-8500

161 River Oaks Dr
Canton, MS 39046
Phone (601) 855-4000

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

1850 Chadwick Dr
Jackson, MS 39204
Phone (601) 376-1000

2124 14th St
Meridian, MS 39301
Phone (601) 483-8811

2080 S Frontage Rd
Ste 100
Vicksburg, MS 39180
Phone (601) 262-1000

2200 Highway 61 N
Ste 2100
Vicksburg, MS 39183
Phone (601) 628-0022

Organizations & group practices 11

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 12

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": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189468800000",
    "number": "1194834747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 PETIT BOIS ST N",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392116707",
            "telephone_number": "601-981-4625",
            "fax_number": "601-981-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 PETIT BOIS ST N",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392116707",
            "telephone_number": "601-981-4625",
            "fax_number": "601-981-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSTON",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "11335",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "MD 11335",
            "primary": true
        },
        {
            "code": "209800000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "MS",
            "license": "MD 11335",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.