Economic Stimulus Act Student Loan Refund 1200 Dollars

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

ECONOMIC STIMULUS ACT STUDENT LOAN REFUND 1200 DOLLARS

Practice address

5001 Hardy St Ste 8
Hattiesburg, MS 39402-1308

Phone

(601) 307-5339

NPI assigned

May 30, 2019

Last updated

Sep 30, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

EPIC SYSTEMS CORPORATION APPLIED INFORMATICS PHYSICIANAs reported in NPPES

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

Authorized official

Name

Dr. Jacob Cornelius ParkerNPI 1326510751

Title

Specialist Technologist

Phone

(650) 253-0000

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 2

• ECONOMIC STIMULUS ACT STUDENT LOAN REFUND 1200 DOLLARS Former legal business name
• EPIC SYSTEMS CORPORATION APPLIED INFORMATICS PHYSICIAN Former legal business name

Electronic endpoints 1

Tax ID family

Health Facility Laboratory5 organizations share this tax ID, including this one

Part of

Epic Systems Corporation Applied Informatics Physician

Other organizations with this tax ID 4

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

• Health Facility Laboratory

  dba Pmgroup

  • Internal Medicine Physician
  • Hattiesburg, MS
  • NPI 1699366542
  NPD tax ID
• Epic Systems Corporation Applied Informatics Physician

  • Private Vehicle
  • Honolulu, HI
  • NPI 1568095503
  NPD tax ID
• Health Facility Laboratory

  • Physiological Laboratory
  • Honolulu, HI
  • NPI 1124585336
  NPD tax ID
• Healthcare Medicare

  • Adult Medicine Physician
  • Saint Louis, MO
  • NPI 1649869678
  NPD tax ID

Locations

Practitioners 1

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.

• Jacob C. Parker, DO, MD

  • Other Specialist/Technologist
  • Hattiesburg, MS
  • NPI 1326510751
  NPD (past) Authorized official

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1255999835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 N MILWAUKEE ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802054322",
            "telephone_number": "650-253-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 HARDY ST STE 8",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021308",
            "telephone_number": "601-307-5339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECONOMIC STIMULUS ACT STUDENT LOAN REFUND 1200 DOLLARS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EPIC SYSTEMS CORPORATION APPLIED INFORMATICS PHYSICIAN",
        "enumeration_date": "2019-05-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "CORNELIUS",
        "authorized_official_title_or_position": "SPECIALIST TECHNOLOGIST",
        "authorized_official_telephone_number": "650-253-0000",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QG0250X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Genetics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "587539997",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://1up.health/patient",
            "affiliation": "N",
            "endpointDescription": "Dr. Parker, Jacob Cornelius, MD. Application Description EMPLOYMENT Relational Technologies: San Jose, California, US 2018-08-27 to present",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "https://1up.health/patient",
            "address_1": "229 Paoakalani Ave",
            "city": "Honolulu",
            "state": "HI",
            "country_code": "US",
            "postal_code": "968153764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ECONOMIC STIMULUS ACT STUDENT LOAN REFUND 1200 DOLLARS",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "EPIC SYSTEMS CORPORATION APPLIED INFORMATICS PHYSICIAN",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Ronda Carol Eason-Hinton, FNP-BC
• Mary Morgan East, PT
• Kerri Michelle Easterling, OTD, OTR/L
• Letoria Easterling
• Quenyatta Echols-Williams, M.D.
• Amanda Leigh Edgar, FNP
• Delana Edgar, FNP
• Edward Brown Specialty Partners of Mississippi, PLLC
• Edward Robert Cohen (dr Edward Robert Cohen)
• Ada Catherine Edwards

• Pharmacy in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.