Individual provider Active NPI

Wilburn Maret Maxwell, M.D.

  • Anesthesiology Physician
  • Jackson, MS
National Provider Identifier
1619911567
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
10299 Issued in MS
Practice address
971 Lakeland Dr
Suite 202
Jackson, MS 39216-4643
Phone
(601) 362-1990
Fax
(601) 362-1988
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 10299 MS Primary

Addresses

Primary practice location

971 Lakeland Dr
Suite 202
Jackson, MS 39216-4643

Mailing address

971 Lakeland Dr
Suite 202
Jackson, MS 39216-4643
Phone (601) 362-1990

Other identifiers 1

IdentifierTypeStateIssuer
00010480MedicaidMS

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
I20101204000009 MS Practitioner - Anesthesiology 0941280614 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Mississippi School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Consultants PAGroup PAC ID 4486637881, 102 clinicians

Practice addresses (Care Compare)

1030 River Oaks Dr
Flowood, MS 39232-9553
Phone (601) 932-1030

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10299MSMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Anesthesia Group, P.a. Anesthesiology CurrentSince Feb 9, 1989 Accepting new patients
Anesthesia Consultants PA Anesthesiology CurrentSince Jan 1, 2020 Accepting new patients
Physicians Anesthesia Group Staffing, LLC Anesthesiology Past Accepting new patients

Locations

971 Lakeland Dr
Jackson, MS 39216
Phone (601) 939-5922

971 Lakeland Dr
Ste 202
Jackson, MS 39216
Phone (601) 362-1990

1030 River Oaks Dr
Jackson, MS 39232
Phone (601) 376-2165

969 Lakeland Dr
Jackson, MS 39216
Phone (601) 200-4644

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1619911567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR",
            "address_2": "SUITE 202",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164643",
            "telephone_number": "601-362-1990",
            "fax_number": "601-362-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR",
            "address_2": "SUITE 202",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164643",
            "telephone_number": "601-362-1990",
            "fax_number": "601-362-1988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "WILBURN",
        "middle_name": "MARET",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "10299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00010480",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.