Active NPI
East Lakeland OB GYN Associates, P.a.
- Obstetrics & Gynecology Physician
- Jackson, MS
National Provider Identifier
1235220112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- Legal business name
- EAST LAKELAND OB GYN ASSOCIATES, P.A.
- Practice address
- 1020 River Oaks Dr
Suite 320
Jackson, MS 39232-9500 - Phone
- (601) 936-1400
- Fax
- (601) 936-0671
- NPI assigned
- Sep 27, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Beverly Ann McMillan, M.D.
- Title
- President
- Phone
- (601) 936-1400
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | Primary |
Addresses
Primary practice location
1020 River Oaks Dr
Suite 320
Jackson, MS 39232-9500
Mailing address
1020 River Oaks Dr
Suite 320
Jackson, MS 39232-9500
Phone (601) 936-1400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9013604 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080610000691 | MS | Part B Supplier - Clinic/Group Practice | 5496836504 |
Receives reassigned benefits from 11 practitioners Practice locations: Flowood, MS |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2139314 | East Lakeland OB/GYN Associates | Provider-performed microscopy | Mar 31, 2027 |
National Provider Directory
National Provider DirectoryLocations
1500 1st Ave N
Ste R112
Birmingham, AL 35203
Phone (205) 802-5455
1020 River Oaks Dr
Ste 320
Jackson, MS 39232
Phone (601) 932-2664
Practitioners & affiliated clinicians
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Flowood, MS
- NPI 1770873721
MS, Obstetrics & Gynecology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1211846400000",
"number": "1235220112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 RIVER OAKS DR",
"address_2": "SUITE 320",
"city": "JACKSON",
"state": "MS",
"postal_code": "392329500",
"telephone_number": "601-936-1400",
"fax_number": "601-936-0671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 RIVER OAKS DR",
"address_2": "SUITE 320",
"city": "JACKSON",
"state": "MS",
"postal_code": "392329500",
"telephone_number": "601-936-1400",
"fax_number": "601-936-0671"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EAST LAKELAND OB GYN ASSOCIATES, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-27",
"last_updated": "2008-05-27",
"status": "A",
"authorized_official_last_name": "MCMILLAN",
"authorized_official_first_name": "BEVERLY",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "601-936-1400",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9013604",
"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 May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.