NPIMap

Organization Active NPI

St. Dominic Medical Associates LLC

Doing business as Family Practice Associates

  • Family Medicine Physician
  • Flowood, MS
National Provider Identifier
1710040712
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST. DOMINIC MEDICAL ASSOCIATES LLC
Doing business as
Family Practice Associates
Practice address
1050 River Oaks Dr
Suite 100
Flowood, MS 39232-9564
Phone
(601) 200-4760
NPI assigned
Dec 19, 2006
Last updated
Jul 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

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

Authorized official

Name
Danielle Stuart
Title
Credentialing Specialist
Phone
(601) 200-4880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1050 River Oaks Dr
Suite 100
Flowood, MS 39232-9564

Mailing address

PO Box 23666
Jackson, MS 39225-0000
Phone (601) 200-4769

Other practice location 1

205A Belle Meade Pt
Flowood, MS 39232-3311
Phone (601) 200-5678

Other identifiers 1

IdentifierTypeStateIssuer
06676033MedicaidMS

Other names 1

  • Family Practice Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Dominic Medical Associates LLC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

680 Highway 51
Ste F
Ridgeland, MS 39157
Phone (601) 200-4760

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1710040712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392250000",
            "telephone_number": "601-200-4769",
            "fax_number": "601-200-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 RIVER OAKS DR",
            "address_2": "SUITE 100",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329564",
            "telephone_number": "601-200-4760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205A Belle Meade Pt",
            "address_purpose": "LOCATION",
            "city": "Flowood",
            "state": "MS",
            "postal_code": "392323311",
            "country_code": "US",
            "telephone_number": "601-200-5678",
            "fax_number": "601-992-0096",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. DOMINIC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "601-200-4880"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06676033",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Practice Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.