NPIMap

Individual provider Active NPI

Julie J Carpenter, MD

  • Family Medicine Physician
  • Southaven, MS
National Provider Identifier
1497757520
Registry record updated Mar 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17222 Issued in MS
Practice address
3451 Goodman Rd E Ste 115
Southaven, MS 38672-9304
Phone
(662) 890-5555
Fax
(662) 890-8899
NPI assigned
Jun 1, 2005
Last updated
Mar 29, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17222 MS Primary

Addresses

Primary practice location

3451 Goodman Rd E Ste 115
Southaven, MS 38672-9304

Mailing address

1022 N Germantown Pkwy
Cordova, TN 38018-5892
Phone (901) 254-8500

Other identifiers 1

IdentifierTypeStateIssuer
P00181717OtherMSMEDICARE RAILROAD

Other names 1

  • Julie Jackson-Carpenter Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041130000086 MS Practitioner - Family Practice 1052302932 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Tennessee, HSC, College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family Medical Clinic of North Ms IncGroup PAC ID 5294790861, 13 clinicians

Practice addresses (Care Compare)

3451 Goodman Rd E
Suite 115
Southaven, MS 38672-9304
Phone (662) 890-5555

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17222MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Group LLC Family Medicine CurrentSince Jul 11, 2022 Accepting new patients
Saint Francis Physician Network, LLC Family Medicine PastSince Feb 5, 2018 Accepting new patients
Sleep Study Clinics of West Tennessee LLC Past Accepting new patients

Locations

8115 Country Village Dr
Cordova, TN 38016
Phone (901) 752-2300

2961 Canada Rd
Ste 105
Lakeland, TN 38002
Phone (901) 388-0115

1211 Union Ave
Ste 330
Memphis, TN 38104
Phone (901) 478-0954

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

Hospital & facility affiliations 8

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": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553817600000",
    "number": "1497757520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 N GERMANTOWN PKWY",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380185892",
            "telephone_number": "901-254-8500",
            "fax_number": "901-754-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3451 GOODMAN RD E STE 115",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729304",
            "telephone_number": "662-890-5555",
            "fax_number": "662-890-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "JULIE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-01",
        "last_updated": "2019-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "17222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00181717",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "JACKSON-CARPENTER",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.