Modupe Harriet Ajisafe, M.D

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

T5940 Issued in MS

Practice address

Department of Family Medicine
2500 N State St
Jackson, MS 39216

Phone

(601) 984-5426

NPI assigned

Apr 16, 2025

Last updated

Nov 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1744761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1306632344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 LAKELAND DR APT 415",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392160005",
            "telephone_number": "346-370-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DEPARTMENT OF FAMILY MEDICINE",
            "address_2": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-984-5426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJISAFE",
        "first_name": "MODUPE",
        "middle_name": "HARRIET",
        "name_prefix": "Miss",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-16",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "T5940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.