NPIMap

Organization Active NPI

St. Dominic Medical Associates LLC

Doing business as St Dominic Family Practice Associates Gluckstadt

  • Family Medicine Physician
  • Madison, MS
National Provider Identifier
1245393255
Registry record updated Aug 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST. DOMINIC MEDICAL ASSOCIATES LLC
Doing business as
St Dominic Family Practice Associates Gluckstadt
St Dominic Family Practice Associates Madison
Practice address
106 Highland Way
Suite 103
Madison, MS 39110-6929
Phone
(601) 200-4750
Fax
(601) 200-4740
NPI assigned
Dec 19, 2006
Last updated
Aug 31, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2018

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

Authorized official

Name
Danielle Stuart
Title
Credentialing Specialist
Phone
(601) 200-4880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

106 Highland Way
Suite 103
Madison, MS 39110-6929

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4749

Other practice location 1

286 Calhoun Station Parkway
Madison, MS 39110
Phone (601) 200-4321

Other identifiers 1

IdentifierTypeStateIssuer
00975207MedicaidMS

Other names 2

  • St Dominic Family Practice Associates Gluckstadt Doing business as
  • St Dominic Family Practice Associates Madison Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Dominic Medical Associates LLC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535673600000",
    "number": "1245393255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 HIGHLAND WAY",
            "address_2": "SUITE 103",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106929",
            "telephone_number": "601-200-4750",
            "fax_number": "601-200-4740"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "286 Calhoun Station Parkway",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "39110",
            "country_code": "US",
            "telephone_number": "601-200-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. DOMINIC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2018-08-31",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "601-200-4880"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00975207",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Dominic Family Practice Associates Gluckstadt",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Dominic Family Practice Associates Madison",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Dominic Family Practice Associates Madison",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.