Active NPI
Dallas Michelle Thomason, PA-C
- Physician Assistant
- Vicksburg, MS
National Provider Identifier
1225361702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00142
- Practice address
- 1907 Mission 66
Vicksburg, MS 39180-3711 - Phone
- (601) 636-1173
- Fax
- (601) 638-8287
- NPI assigned
- Sep 15, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00142 | MS | Primary |
Addresses
Primary practice location
1907 Mission 66
Vicksburg, MS 39180-3711
Mailing address
1907 Mission 66
Vicksburg, MS 39180-3711
Phone (601) 636-1173
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vicksburg Clinic LLC | Current | Accepting new patients |
Locations
309A Morrison Dr
Clinton, MS 39056
Phone (601) 924-1877
54 Sgt Prentiss Dr
Ste 103
Natchez, MS 39120
Phone (601) 883-5858
104 McAuley Dr
Vicksburg, MS 39183
Phone (601) 638-7271
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Vicksburg, MS
- NPI 1790711158
-
- Emergency Medicine Physician
- Jackson, MS
- NPI 1730687740
-
- Emergency Medicine Physician
- Tupelo, MS
- NPI 1841664661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395705600000",
"number": "1225361702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1907 MISSION 66",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803711",
"telephone_number": "601-636-1173",
"fax_number": "601-638-8287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1907 MISSION 66",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803711",
"telephone_number": "601-636-1173",
"fax_number": "601-638-8287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMASON",
"first_name": "DALLAS",
"middle_name": "MICHELLE",
"name_prefix": "Miss",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-15",
"last_updated": "2014-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MS",
"license": "PA00142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.