Individual provider Active NPI

Justin L Cole, NP

  • Gerontology Nurse Practitioner
  • Laurel, MS
National Provider Identifier
1588053052
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
885111 Issued in MS
Practice address
1203 Jefferson St
Laurel, MS 39440-4354
Phone
(601) 649-2863
Fax
(601) 649-9479
NPI assigned
Jan 21, 2015
Last updated
Sep 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R885111 MS
Gerontology Nurse Practitioner 363LG0600X 885111 MS Primary

Addresses

Primary practice location

1203 Jefferson St
Laurel, MS 39440-4354

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4560

Other practice location 1

971 Lakeland Dr Ste 557
Jackson, MS 39216-4661
Phone (601) 200-4560

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jcole2546020@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150202001935 MS Practitioner - Nurse Practitioner 9436474061 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

106 Highland Way
Madison, MS 39110-6933

971 Lakeland Dr
Suite 557
Jackson, MS 39216-4661
Phone (601) 200-4560

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R885111MSMDNurse Practitioner
885111MSMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Dominic Medical Associates LLC CurrentSince Dec 1, 2018 Accepting new patients
St. Dominic Medical Associates LLC CurrentSince Dec 1, 2018 Accepting new patients
Jefferson Neurology Clinic, LLC CurrentSince Jan 28, 2018 Accepting new patients
St Dominic Medical Associates LLC Past Accepting new patients

Locations

971 Lakeland Dr
Ste 557
Jackson, MS 39216
Phone (601) 200-4560

319 S 13th Ave
Laurel, MS 39440
Phone (601) 426-2140

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

Interoperability endpoints

  • Direct secure messaging: jcole2546020@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1421798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1588053052",
    "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": "601-200-4560",
            "fax_number": "601-200-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 JEFFERSON ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404354",
            "telephone_number": "601-649-2863",
            "fax_number": "601-649-9479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "971 Lakeland Dr Ste 557",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164661",
            "country_code": "US",
            "telephone_number": "601-200-4560",
            "fax_number": "601-200-4580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLE",
        "first_name": "JUSTIN",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-21",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R885111",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "885111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcole2546020@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-EPIC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jcole2546020@direct.casso.us.com",
            "address_1": "971 Lakeland Dr Ste 557",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164661",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "971 Lakeland Dr Ste 557",
            "city": "Jackson",
            "state": "MS",
            "country_code": "US",
            "postal_code": "392164661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

Verify at the official NPI Registry.