Jackson Neuroscience Center

Primary specialty

PsychoanalystTaxonomy code 102L00000X

License

16393 Issued in MS

Legal business name

JACKSON NEUROSCIENCE CENTER

Practice address

207 W Jackson St
Suite 1
Ridgeland, MS 39157-2355

Phone

(601) 992-5943

Fax

(601) 992-9152

NPI assigned

Jan 15, 2016

Organization subpart

No

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

Authorized official

Name

Ron Milone

Title

MGR

Phone

(601) 992-5943

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9276/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1417314865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 W JACKSON ST",
            "address_2": "SUITE 1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572355",
            "telephone_number": "601-992-5943",
            "fax_number": "601-992-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W JACKSON ST",
            "address_2": "SUITE 1",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572355",
            "telephone_number": "601-992-5943",
            "fax_number": "601-992-9152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON NEUROSCIENCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "MILONE",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "601-992-5943"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychoanalyst",
            "state": "MS",
            "license": "16393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "G50211",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118254",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis N Irby, FNP
• Irving Eye Care LLC
• Quatrisa Irving, O.D.
• Philip Ivanov, D.C.
• Donny R Ivy, PT
• Jackson Pediatric Associates
• Jackson Psychiatry Group
• Jackson Psychiatry Group
• Andrew Noble Jackson, LPC
• Cassandra Georgette Jackson, M.S.W.

• All providers in Ridgeland, MS
• Psychoanalyst in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.