North Jackson Medical Clinic PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

15143 Issued in MS

Legal business name

NORTH JACKSON MEDICAL CLINIC PLLC

Practice address

5160 Galaxie Dr
Jackson, MS 39206-4308

Phone

(601) 713-0890

Fax

(601) 366-3415

NPI assigned

Sep 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Adesola F Shekoni, MDNPI 1972650885

Title

Physician

Phone

(601) 713-0890

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kaye Killings, CFNP

  • Adult Health Nurse Practitioner
  • Jackson, MS
  • NPI 1881636306
  Medicare reassignment Care Compare group NPD
• Adesola F Shekoni, MD

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1972650885
  Medicare reassignment NPD Authorized official
• Nurudeen Shekoni, MD

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1841347770
  Medicare reassignment Care Compare group NPD
• Oladimeji Samson Akiode, MD

  • Hospitalist Physician
  • Tyler, TX
  • NPI 1922078120

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1659471407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4522",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392964522",
            "telephone_number": "601-713-0890",
            "fax_number": "601-366-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5160 GALAXIE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392064308",
            "telephone_number": "601-713-0890",
            "fax_number": "601-366-3415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH JACKSON MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "SHEKONI",
        "authorized_official_first_name": "ADESOLA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "601-713-0890",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "15143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117502",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS OF MISSISSIPPI",
            "identifier": "220338401B",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115572",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9015073",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS OF MISSISSIPPI",
            "identifier": "109808399B",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aubrey Claire Norris
• David Ronald Norris, M.D.
• John A Norris, CRNA
• Timothy A Norris, GC-C
• North Grove Assisted Living
• North Lion Hospice & Palliative Care, LLC
• North Street Healthcare LLC
• Durham North, M.D.
• Kelsey A North, PA-C
• James A. Northcutt, M.D.

• Internal Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; 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.