Active NPI
Rochel Yvette Thornton, M.D.
- Family Medicine Physician
- Jackson, MS
National Provider Identifier
1699888487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 17054
- Practice address
- 1500 E Woodrow Wilson Ave
Primary Care Green Clinic
Jackson, MS 39216-5116 - Phone
- (601) 362-4471
- Fax
- (601) 368-4089
- NPI assigned
- Aug 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 17054 | MS | Primary |
Addresses
Primary practice location
1500 E Woodrow Wilson Ave
Primary Care Green Clinic
Jackson, MS 39216-5116
Mailing address
1500 E Woodrow Wilson Ave
Primary Care Green Clinic
Jackson, MS 39216-5116
Phone (601) 362-4471
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09406009 | Medicaid | MS | |
| 17054 | Other | MS | LICENSE NUMBER |
Other names 1
- Rochel Yvette Thornton-Walker
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101210000157 | MS | Practitioner - Family Practice | 7012104458 | Practice locations: Jackson, MS |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1699888487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"address_2": "PRIMARY CARE GREEN CLINIC",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116",
"telephone_number": "601-362-4471",
"fax_number": "601-368-4089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"address_2": "PRIMARY CARE GREEN CLINIC",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116",
"telephone_number": "601-362-4471",
"fax_number": "601-368-4089"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THORNTON",
"first_name": "ROCHEL",
"middle_name": "YVETTE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-16",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MS",
"license": "17054",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09406009",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "17054",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ROCHEL",
"last_name": "THORNTON-WALKER",
"middle_name": "YVETTE",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}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 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.