Organization Active NPI

First Intermed Corporation

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1669406658
Registry record updated Mar 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FIRST INTERMED CORPORATION
Practice address
5606 Old Canton Rd
Jackson, MS 39211-4217
Phone
(601) 957-3333
Fax
(601) 957-3334
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2011

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

Authorized official

Name
Sam Scott
Title
Physician Services Coordinator
Phone
(601) 898-7525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MS Primary

Addresses

Primary practice location

5606 Old Canton Rd
Jackson, MS 39211-4217

Mailing address

5606 Old Canton Rd
Jackson, MS 39211-4217
Phone (601) 957-3333

Other identifiers 11

IdentifierTypeStateIssuer
CH0373OtherMSRAILROAD MEDICARE
CH9760OtherMSRAILROAD MEDICARE
CH7890OtherMSRAILROAD MEDICARE
CH7897OtherMSRAILROAD MEDICARE
09015301MedicaidMS
CH7894OtherMSRAILROAD MEDICARE
CH7896OtherMSRAILROAD MEDICARE
CH0704OtherMSRAILROAD MEDICARE
CH7891OtherMSRAILROAD MEDICARE
CH7892OtherMSRAILROAD MEDICARE
CH7895OtherMSRAILROAD MEDICARE

Other names 1

  • MEA Medical Clinics Doing business as

National Provider Directory

National Provider Directory

Locations

5606 Old Canton Rd
Jackson, MS 39211
Phone (601) 924-3350

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301443200000",
    "number": "1669406658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5606 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114217",
            "telephone_number": "601-957-3333",
            "fax_number": "601-957-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5606 OLD CANTON RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114217",
            "telephone_number": "601-957-3333",
            "fax_number": "601-957-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST INTERMED CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2011-03-30",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "PHYSICIAN SERVICES COORDINATOR",
        "authorized_official_telephone_number": "601-898-7525"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH0373",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH9760",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH7890",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH7897",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015301",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH7894",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH7896",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH0704",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH7891",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH7892",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH7895",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEA Medical Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.