Individual provider Active NPI

Jennifer C Shores, M.D.

  • Pediatric Cardiology Physician
  • Jackson, MS
National Provider Identifier
1568493450
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
17022 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 984-5250
Fax
(601) 984-5283
NPI assigned
Jul 6, 2006
Last updated
May 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X 17022 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5250

Other practice location 1

2124 14th St
Meridian, MS 39301-4040
Phone (601) 553-6000

Other practice location 2

1102 Constitution Ave
Meridian, MS 39301-4001
Phone (601) 703-5000

Other identifiers 2

IdentifierTypeStateIssuer
158189MedicaidAL
0123172MedicaidMS

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
I20071212000136 MS Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology)Practitioner - Other (Physician) 2466542683 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Johns Hopkins University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

965 Avent Dr
Grenada, MS 38901-5045
Phone (662) 227-7444

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Regional Medical Center CurrentSince Apr 25, 2025 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Aug 1, 2012 Accepting new patients
Anderson Regional Medical Center Current Accepting new patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Aug 1, 2012 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Oct 11, 2019 Accepting new patients
Anderson Regional Medical Center CurrentSince Apr 25, 2025 Accepting new patients
University Radiation Oncology Consultants, PLLC Past Accepting new patients
University Pediatric Associates, PLLC Past Accepting new patients
University Physicians, PLLC Past Accepting new patients

Locations

965 Avent Dr
Ste 100A
Grenada, MS 38901
Phone (662) 227-7000

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

1815 Hospital Dr
Jackson, MS 39204
Phone (601) 815-4775

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

2500 N State St
#4200
Jackson, MS 39216

421 S Stadium Cir
Jackson, MS 39216
Phone (601) 984-5211

1102 Constitution Ave
Meridian, MS 39301
Phone (601) 693-2511

2124 14th St
Meridian, MS 39301
Phone (601) 483-8811

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jshores6245@ummc.direct-ci.com

Organizations & group practices 12

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 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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1568493450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5250",
            "fax_number": "601-984-5283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5250",
            "fax_number": "601-984-5283"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2124 14th St",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393014040",
            "country_code": "US",
            "telephone_number": "601-553-6000",
            "fax_number": "601-703-0124",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1102 Constitution Ave",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "MS",
            "postal_code": "393014001",
            "country_code": "US",
            "telephone_number": "601-703-5000",
            "fax_number": "601-703-0124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHORES",
        "first_name": "JENNIFER",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MS",
            "license": "17022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158189",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0123172",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.