Jeanne Mariah Lilly, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

621115 Issued in MS

Practice address

785 Ohio Ave Ste 3E
Clarksdale, MS 38614-6215

Phone

(662) 351-0702

Fax

(662) 351-0703

NPI assigned

Dec 29, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Sai Sanjeevani Medical Group LLC

  • Internal Medicine Physician
  • Clarksdale, MS
  • NPI 1871361121
  Medicare reassignment NPD

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

{
    "created_epoch": "1703808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1457120545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 OHIO AVE STE 3E",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146215",
            "telephone_number": "662-351-0702",
            "fax_number": "662-351-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 OHIO AVE STE 3E",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146215",
            "telephone_number": "662-351-0702",
            "fax_number": "662-351-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "JEANNE",
        "middle_name": "MARIAH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-29",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "621115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200010527",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Celia C Lavender, M.S., CCC-SLP
• Chester L. Layne, D.D.S.
• Pertrice Lee, M.ED.
• Lucius Lewis Jr., CRNA
• Margaret Chandler Lewis, NP
• Lion Hospice & Palliative Care, LLC
• Kolby Nicole Little, MED, LPC, NCC
• Lillie Mae Lockett
• Long Family Dentistry Inc
• Robert Earl Long Sr., DDS

• Psychologist in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.