Craig Kenneth Hallstrom, M.D.

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

18514 Issued in MS

Practice address

2500 N State St
Jackson, MS 39216-4500

Phone

(601) 815-8173

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Specialty

Critical Care (Intensivists)Also: Pediatric Medicine

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of Mississippi - University of Mississippi Medical CenterGroup PAC ID 1850293036, 956 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: challstrom6489@ummc.direct-ci.com

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.

• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment Care Compare group NPD
• State of Mississippi - University of Mississippi Medical Center

  • Prosthetic/Orthotic Supplier
  • Jackson, MS
  • NPI 1235019530
  NPD
• University Radiation Oncology Consultants, PLLC

  • Radiation Oncology Physician
  • Jackson, MS
  • NPI 1316026818
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396310400000",
    "number": "1598709503",
    "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": "601-815-8173"
        },
        {
            "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": "601-815-8173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLSTROM",
        "first_name": "CRAIG",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2014-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MS",
            "license": "18514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "512I370060",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07076371",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1603767",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157470",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Claude Hall, DO
• Talyr Hall, MD
• William Hall, MS
• Zachary Halliwell, CRNA
• Maury W Hallman, CRNA
• Joseph Bryant Halsch
• James R Haltom, MD
• David Elder Hamby, N.P
• Fawaaz Mohsin Hameed
• Angela Renee Hamilton, PHARM.D.

• Pediatric Critical Care Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Pediatric Critical Care Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2014; 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.

Verify at the official NPI Registry.