Active NPI
Jonathan Patrick Pollock, MD
- Cardiovascular Disease Physician
- Keesler AFB, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 0101259514
- Practice address
- 301 Fisher St
Keesler AFB, MS 39534-2508 - Phone
- (228) 376-3811
- NPI assigned
- Feb 7, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 29281 | MS | |
| Cardiovascular Disease Physician | 207RC0000X | 0101259514 | VA | Primary |
Addresses
Primary practice location
301 Fisher St
Keesler AFB, MS 39534-2508
Mailing address
301 Fisher St
Keesler AFB, MS 39534-2508
Phone (228) 376-3811
Other practice location 1
415 S 28th Ave
Hattiesburg, MS 39401-7246
Phone (601) 268-5800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05684216 | Medicaid | MS |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 264-6000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29281 | MS | MD | Cardiovascular Disease Physician |
| 0101259514 | VA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hattiesburg Clinic PA | Current | Accepting new patients | |
| Hattiesburg Clinic, PA | Current | Accepting new patients | |
| Hattiesburg Clinic, PA | Past | Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Past | Accepting new patients |
Locations
415 S 28th Ave
Fl 3
Hattiesburg, MS 39401
Phone (601) 268-1734
415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606
Interoperability endpoints
- jpollock122297@directpatientrecord.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.
-
- Multi-Specialty Clinic/Center
- Hattiesburg, MS
- NPI 1740213446
-
dba Flowood Primary Care
- Primary Care Clinic/Center
- Flowood, MS
- NPI 1912600354
-
dba Laurel Dialysis Unit
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Laurel, MS
- NPI 1245263540
-
dba Holmes County Hospital and Clinic
- Critical Access Hospital
- Lexington, MS
- NPI 1386630705
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Hattiesburg, MS
- NPI 1225041809
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1558785782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 FISHER ST",
"city": "KEESLER AFB",
"state": "MS",
"postal_code": "395342508",
"telephone_number": "228-376-3811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 FISHER ST",
"city": "KEESLER AFB",
"state": "MS",
"postal_code": "395342508",
"telephone_number": "228-376-3811"
}
],
"practiceLocations": [
{
"address_1": "415 S 28th Ave",
"address_purpose": "LOCATION",
"city": "Hattiesburg",
"state": "MS",
"postal_code": "394017246",
"country_code": "US",
"telephone_number": "601-268-5800",
"fax_number": "601-579-5240",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POLLOCK",
"first_name": "JONATHAN",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-07",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "MS",
"license": "29281",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "VA",
"license": "0101259514",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05684216",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Keesler AFB, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.