Lauderdale Medical Group PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LAUDERDALE MEDICAL GROUP PLLC

Doing business as

Lauderdale Medical Group

Practice address

11 E Jefferson St
Pontotoc, MS 38863-2807

Phone

(662) 419-1260

NPI assigned

Oct 16, 2023

Last updated

Mar 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jessica Anne Lauderdale, DONPI 1093095523

Title

Owner

Phone

(662) 489-6041

Specialties & licenses 1

Addresses

Other names 1

• Lauderdale Medical Group Doing business as

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, and the practitioner matching its NPPES authorized official.

• Jessica Anne Lauderdale, DO

  • Family Medicine Physician
  • Pontotoc, MS
  • NPI 1093095523
  Medicare reassignment NPD Authorized official
• Austin Reed Knight, PA-C

  • Physician Assistant
  • Pontotoc, MS
  • NPI 1427689751
  NPD
• Christopher Lane Park, DO

  • Family Medicine Physician
  • Pontotoc, MS
  • NPI 1710181078
  NPD
• Leslie Kay Eaton

  • Family Nurse Practitioner
  • New Albany, MS
  • NPI 1417504796
  NPD (past)

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

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1689456527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 EMBERWOOD CT",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388017861",
            "telephone_number": "662-419-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 E JEFFERSON ST",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388632807",
            "telephone_number": "662-419-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUDERDALE MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-16",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "LAUDERDALE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-489-6041",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lauderdale Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lauderdale Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charity Kidd
• Michael Don King, NURSE PRACTITIONER
• Austin Reed Knight, PA-C
• Lynne Knight, LPC
• Lauren Elizabeth Laenen, MOT,OTR/L
• Jessica Anne Lauderdale, DO
• Life Seasons Counseling, LLC
• Lindsay Clinic PA
• Patricia Anne Lindsay, N.P.
• Melissa Guntharp Lindsey, R.PH.

• Primary Care Clinic/Center in Pontotoc, MS
• Providers in Pontotoc, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.