Alice Shackelford, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

905551 Issued in MS

Practice address

971 Lakeland Dr Ste 950
Jackson, MS 39216-4608

Phone

(601) 362-6900

Fax

(601) 362-6111

NPI assigned

Jan 24, 2023

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

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mississippi Arthritis Clinic PLLCGroup PAC ID 6800971946, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mississippi Baptist Medical Center Hospital, Jackson, MS, CCN 250102

Merit-based Incentive Payment System (MIPS)

Final score

87.89 of 100Reported as group

Quality

87.92

Improvement activities

40

Cost

75.75

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: alice.shackelford.p1@direct.mac.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mississippi Arthritis Clinic PLLC

  • Rheumatology Physician
  • Flowood, MS
  • NPI 1275713471
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mississippi Baptist Medical Center, Inc.

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1710909585
  Care Compare affiliation

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

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1316653397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 296",
            "city": "BENTON",
            "state": "MS",
            "postal_code": "390390296",
            "telephone_number": "769-234-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 950",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164608",
            "telephone_number": "601-362-6900",
            "fax_number": "601-362-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "ALICE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-24",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "905551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyscia Severance, MD
• Annilin Masan Severns, M.D.
• Mary Jean Sewell, PHARMD
• Mansour Shabazz, PHARMD
• Tyler Reshadrich-Shaurice Shack, M.D.
• Krishna Naimish Shah
• Murad Ali Shah, MD
• Neha Bansi Shah, MD
• Abdullah Shaheen, MD
• Noor Ul Ain Shahid, MD

• Family Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.
• 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.