NPIMap

Organization Active NPI

Relias Emergency Medicine Specialists of St Dominic LLC

  • Emergency Medicine Physician
  • Jackson, MS
National Provider Identifier
1235808122
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
RELIAS EMERGENCY MEDICINE SPECIALISTS OF ST DOMINIC LLC
Practice address
969 Lakeland Dr
Jackson, MS 39216-4606
Phone
(781) 280-1699
NPI assigned
Sep 13, 2021
Last updated
Oct 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Authorized official

Name
Jennifer Kathryn Wakeford
Title
Enterprise Cfo
Phone
(205) 901-5103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

969 Lakeland Dr
Jackson, MS 39216-4606

Mailing address

PO Box 31037
Charlotte, NC 28231-1037
Phone (855) 691-9890

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL EHR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211029000889 MS Part B Supplier - Clinic/Group Practice 2466840152 Receives reassigned benefits from 38 practitioners
Practice locations: Jackson, MS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760572800000",
    "number": "1235808122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31037",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282311037",
            "telephone_number": "855-691-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164606",
            "telephone_number": "781-280-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIAS EMERGENCY MEDICINE SPECIALISTS OF ST DOMINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-13",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A",
        "authorized_official_last_name": "WAKEFORD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "KATHRYN",
        "authorized_official_title_or_position": "ENTERPRISE CFO",
        "authorized_official_telephone_number": "205-901-5103"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EHR",
            "affiliation": "N",
            "endpointDescription": "electronic health record",
            "address_1": "969 Lakeland Dr",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Oct 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.