Individual provider Active NPI

Zachary Kriete Baldwin, M.D.

  • Vascular Surgery Physician
  • Jackson, MS
National Provider Identifier
1487778239
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
20344 Issued in MS
Practice address
971 Lakeland Dr Ste 1250
Jackson, MS 39216-4609
Phone
(601) 200-2990
Fax
(601) 200-5939
NPI assigned
Mar 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A76552 CA
Vascular Surgery Physician 2086S0129X 20344 MS Primary

Addresses

Primary practice location

971 Lakeland Dr Ste 1250
Jackson, MS 39216-4609

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4749

Other identifiers 2

IdentifierTypeStateIssuer
03053543MedicaidMS
P00641839OtherMSRAILROAD MEDICARE

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
I20080916000194 MS Practitioner - Vascular SurgeryPractitioner - General Surgery 1759458896 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Chicago, Pritzker School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Dominic Medical Associates LLCGroup PAC ID 0446303168, 130 clinicians

Practice addresses (Care Compare)

106 Highland Way
Madison, MS 39110-6933

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-3100

Hospital & facility affiliations

  • St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)44
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A76552CAMDSurgery Physician
20344MSMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Dominic Medical Associates LLC CurrentSince Aug 1, 2014 Accepting new patients
St. Dominic Medical Associates LLC CurrentSince Aug 1, 2014 Accepting new patients
St Dominic Medical Associates LLC Past Accepting new patients
St Dominic-Jackson Memorial Hospital Past Accepting new patients

Locations

971 Lakeland Dr
Ste 1250
Jackson, MS 39216
Phone (601) 200-5955

970 Lakeland Dr
Ste 43
Jackson, MS 39216
Phone (601) 200-4880

106 Highland Way
Ste 202
Madison, MS 39110
Phone (601) 200-3376

Interoperability endpoints

  • Direct secure messaging: zbaldwin2548778@direct.casso.us.com

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1487778239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4749",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 1250",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164609",
            "telephone_number": "601-200-2990",
            "fax_number": "601-200-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALDWIN",
        "first_name": "ZACHARY",
        "middle_name": "KRIETE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A76552",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MS",
            "license": "20344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03053543",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00641839",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.