Jerry Lee Stork, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00079 Issued in MS

Practice address

3688 Veterans Memorial Dr
200
Hattiesburg, MS 39401-8246

Phone

(601) 554-7402

Fax

(601) 554-7488

NPI assigned

Jul 16, 2006

Last updated

Oct 19, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, MS, AL3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency Room Group LTD

  • Emergency Medicine Physician
  • Pascagoula, MS
  • NPI 1093112039
  Medicare reassignment
• Hancock Emergency Group LLC

  • Emergency Medicine Physician
  • Bay St Louis, MS
  • NPI 1295142396
  Medicare reassignment
• Mississippi Emergency Department Services PC

  • Emergency Medicine Physician
  • Pascagoula, MS
  • NPI 1881427961
  Medicare reassignment
• Singing River Gulfport

  dba Singing River Gulfport Ambulatory

  • Multi-Specialty Clinic/Center
  • Gulfport, MS
  • NPI 1861010159
  Medicare reassignment
• Inphynet Contracting Services LLC

  • Emergency Medicine Physician
  • Delray Beach, FL
  • NPI 1073556767
  Medicare reassignment
• Medical Services of Meridian, Inc.

  • Emergency Medicine Physician
  • Memphis, TN
  • NPI 1174095988

  MS

  Medicare reassignment
• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459
  Medicare reassignment
• Southwest Florida Emergency Management LLC

  • Emergency Medicine Physician
  • Naples, FL
  • NPI 1780911206
  Medicare reassignment
• Singing River Gulfport

  • Internal Medicine Physician
  • Gulfport, MS
  • NPI 1487327193
  NPD
• Cooper Family Medical Center Inc.

  • Clinic/Center
  • Pascagoula, MS
  • NPI 1356478564
  NPD (past)
• Mississippi Em-I Medical Services PC

  • Nurse Practitioner
  • De Kalb, MS
  • NPI 1407412976

  Physician Assistant

  NPD (past)
• Ipn Emergency Physicians of North Florida PA

  • Emergency Medicine Physician
  • Starke, FL
  • NPI 1619287158

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1467479550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3688 VETERANS MEMORIAL DR",
            "address_2": "200",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018246",
            "telephone_number": "601-554-7402",
            "fax_number": "601-554-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3688 VETERANS MEMORIAL DR",
            "address_2": "200",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018246",
            "telephone_number": "601-554-7402",
            "fax_number": "601-554-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORK",
        "first_name": "JERRY",
        "middle_name": "LEE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-16",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA00079",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103513",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Stokes, C.R.N.A.
• Tiffany Tinette Stokes, B.S.
• Adam Lane Stone
• Summer A Stone, CRNA
• Sarah Whitley Stonefield, DMD
• Vanessa Storozuk, APRN, FNP-C
• David C Stout, MD
• Ashia Kenya Stovall
• Kimberlea Stovall, M.S., CCC-SLP
• Presley Dyess Stovall

• Physician Assistant in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.