Individual provider Active NPI

Elisa Miguel-Qin, MD

  • Pediatrics Physician
  • Jackson, MS
National Provider Identifier
1336768795
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
31810 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 984-6562
Fax
(601) 918-2086
NPI assigned
Apr 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 31810 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

PO Box 11407
Birmingham, AL 35246-2130
Phone (601) 398-5707

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240911002025 MS Practitioner - Pediatric Medicine 4284046087 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Sep 30, 2024 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Sep 30, 2024 Accepting new patients

Locations

965 Avent Dr
Ste 100A
Grenada, MS 38901
Phone (662) 227-7000

960 Avent Dr
#J
Grenada, MS 38901
Phone (662) 227-6450

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

421 S Stadium Cir
Jackson, MS 39216
Phone (601) 984-5211

2500 N State St
Ste 4200
Jackson, MS 39216

Interoperability endpoints

  • Direct secure messaging: emiguelqin78483@ummc.direct-ci.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1336768795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352462130",
            "telephone_number": "601-398-5707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-6562",
            "fax_number": "601-918-2086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIGUEL-QIN",
        "first_name": "ELISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-15",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "31810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.