NPIMap

Organization Active NPI

Mid-South Infectious Disease Associates, PLLC

  • Infectious Disease Physician
  • Memphis, TN
National Provider Identifier
1245266733
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
MD0000026445 Issued in TN
Legal business name
MID-SOUTH INFECTIOUS DISEASE ASSOCIATES, PLLC
Practice address
6029 Walnut Grove Rd Ste 209
Memphis, TN 38120-2112
Phone
(901) 681-0778
Fax
(901) 821-9987
NPI assigned
Jun 25, 2006
Last updated
Jan 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Authorized official

Name
Manoj K Jain, MDNPI 1003858168
Title
President
Phone
(901) 681-0778

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X MD0000026445 TN Primary

Addresses

Primary practice location

6029 Walnut Grove Rd Ste 209
Memphis, TN 38120-2112

Mailing address

6029 Walnut Grove Rd Ste 209
Memphis, TN 38120-2112
Phone (901) 681-0778

Other identifiers 2

IdentifierTypeStateIssuer
3723463MedicaidTN
009015743MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040401001700 TN Part B Supplier - Clinic/Group Practice 0547252124 Receives reassigned benefits from 15 practitioners
Practice locations: Memphis, TN
O20040508000385 MS Part B Supplier - Clinic/Group Practice 0547252124 Receives reassigned benefits from 14 practitioners
Practice locations: Southaven, MS

National Provider Directory

National Provider Directory

Locations

401 Southcrest Cir
Ste 203
Southaven, MS 38671
Phone (662) 775-4025

6029 Walnut Grove Rd
Ste 209
Memphis, TN 38120
Phone (901) 681-0778

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1245266733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6029 WALNUT GROVE RD STE 209",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202112",
            "telephone_number": "901-681-0778",
            "fax_number": "901-821-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6029 WALNUT GROVE RD STE 209",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202112",
            "telephone_number": "901-681-0778",
            "fax_number": "901-821-9987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-SOUTH INFECTIOUS DISEASE ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "MANOJ",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-681-0778",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TN",
            "license": "MD0000026445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3723463",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009015743",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.