Mercy Clinic of Jackson, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

31497 Issued in KY

Legal business name

MERCY CLINIC OF JACKSON, PLLC

Practice address

1550 Highway 15 S
Suite 80
Jackson, KY 41339-7247

Phone

(606) 693-0343

Fax

(606) 693-0322

NPI assigned

May 30, 2007

Last updated

Oct 4, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan Pratt

Title

Clinic Manager

Phone

(606) 693-0343

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Cesar Ocampo Agtarap, M.D.

  • Internal Medicine Physician
  • Jackson, KY
  • NPI 1285635698
  Medicare reassignment NPD

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1306047105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 HIGHWAY 15 S",
            "address_2": "SUITE 80",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413397247",
            "telephone_number": "606-693-0343",
            "fax_number": "606-693-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 HIGHWAY 15 S",
            "address_2": "SUITE 80",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413397247",
            "telephone_number": "606-693-0343",
            "fax_number": "606-693-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC OF JACKSON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "606-693-0343"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "KY",
            "license": "31497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Ann McIntosh, PHARMD
• Aloysius Francis Meives IV
• Edgar A D Mendoza, M.D.
• Pablo Alabanza Merced, M.D.
• Peter Anthony Merced
• Crystal Dawn Meyer, MSN, APRN, FNP-C
• Robert Scott Moore, PHARMD
• Trudy Ann Moore, M.D.
• James Brian Morris, P.T.
• Jonathan Charles Morris, PT

• Specialist in Jackson, KY
• Providers in Jackson, KY by specialty
• Specialist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.