NPIMap

Organization Active NPI

Jackson Heart Clinic. P.a.

  • Cardiovascular Disease Physician
  • Jackson, MS
National Provider Identifier
1659318558
Registry record updated Apr 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
JACKSON HEART CLINIC. P.A.
Practice address
970 Lakeland Dr
Suite 61
Jackson, MS 39216-4640
Phone
(601) 982-7850
Fax
(601) 326-6278
NPI assigned
May 31, 2006
Last updated
Apr 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2014

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

Authorized official

Name
Ms. Stephanie S Egger
Title
Ceo
Phone
(601) 982-7850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

970 Lakeland Dr
Suite 61
Jackson, MS 39216-4640

Mailing address

970 Lakeland Dr
Suite 61
Jackson, MS 39216-4640
Phone (601) 982-7850

Other identifiers 1

IdentifierTypeStateIssuer
09011314MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050615000346 MS Part B Supplier - Clinic/Group Practice 0547204091 Receives reassigned benefits from 51 practitioners
Practice locations: Flowood, MS; Jackson, MS; Ridgeland, MS

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D0966300Jackson Heart Clinic970 Lakeland Drive Suite 61, Jackson, MS 39216Certificate of waiverJul 13, 2028

National Provider Directory

National Provider Directory

Locations

185 Medical Pkwy
Flowood, MS 39232

185 Medical Pkwy
Ste 102
Flowood, MS 39232

185 Medical Pkwy
Ste 202
Flowood, MS 39232

1040 River Oaks Dr
Ste 103
Jackson, MS 39232
Phone (601) 326-2599

970 Lakeland Dr
Ste 61
Jackson, MS 39216
Phone (601) 200-2780

326 Commerce Center Dr
Ste 2000
Ridgeland, MS 39157

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397088000000",
    "number": "1659318558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "970 LAKELAND DR",
            "address_2": "SUITE 61",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164640",
            "telephone_number": "601-982-7850",
            "fax_number": "601-326-6278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 LAKELAND DR",
            "address_2": "SUITE 61",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164640",
            "telephone_number": "601-982-7850",
            "fax_number": "601-326-6278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HEART CLINIC. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2014-04-10",
        "status": "A",
        "authorized_official_last_name": "EGGER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "601-982-7850",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09011314",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.