NPIMap

Organization Active NPI

St Dominic Medical Associates LLC

Doing business as St Dominic Pallative Care

  • Hospitalist Physician
  • Jackson, MS
National Provider Identifier
1285987578
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
ST DOMINIC MEDICAL ASSOCIATES LLC
Doing business as
St Dominic Pallative Care
St. Dominic Hospital Medicine
Practice address
969 Lakeland Dr
Jackson, MS 39216
Phone
(601) 200-5900
Fax
(601) 200-0204
NPI assigned
Oct 24, 2012
Last updated
Mar 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ST DOMINIC JACKSON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

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

Authorized official

Name
Danielle Stuart
Title
Credentialing Representative 2
Phone
(601) 200-4880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X Primary

Addresses

Primary practice location

969 Lakeland Dr
Jackson, MS 39216

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4644

Other names 2

  • St Dominic Pallative Care Doing business as
  • St. Dominic Hospital Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090728000821 MS Part B Supplier - Clinic/Group Practice 0446303168 Receives reassigned benefits from 143 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, MS; Madison, MS; Jackson, MS; Flowood, MS; Clinton, MS; Brandon, MS

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Chemical Dependency Uni

Locations

1297 W Government St
Brandon, MS 39042
Phone (601) 200-4790

950 Highway 80 E
Clinton, MS 39056
Phone (601) 924-7882

971 Lakeland Dr
Ste 211
Jackson, MS 39216
Phone (601) 200-4350

971 Lakeland Dr
Ste 250
Jackson, MS 39216
Phone (601) 200-4860

971 Lakeland Dr
Ste 750
Jackson, MS 39216
Phone (601) 200-5955

971 Lakeland Dr
Ste 954
Jackson, MS 39216
Phone (601) 200-4714

Practitioners & affiliated clinicians

Practitioners 134

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 134

NPI Registry JSON

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647820800000",
    "number": "1285987578",
    "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": "601-200-4644",
            "fax_number": "601-200-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-200-5900",
            "fax_number": "601-200-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST DOMINIC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST DOMINIC JACKSON MEMORIAL HOSPITAL",
        "enumeration_date": "2012-10-24",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CREDENTIALING REPRESENTATIVE 2",
        "authorized_official_telephone_number": "601-200-4880"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Dominic Pallative Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Dominic Hospital Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 21, 2022; 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.