Centerwell Senior Primary Care Ms PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CENTERWELL SENIOR PRIMARY CARE MS PC

Practice address

1220 E Northside Dr Ste 220
Jackson, MS 39211-5503

Phone

(601) 298-4173

Fax

(877) 866-2356

NPI assigned

Jan 25, 2023

Organization subpart

Yes

Parent organization

CENTERWELL SENIOR PRIMARY CARE MS PCAs reported in NPPES

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

Authorized official

Name

Angie Martinez

Title

Senior Credentialing Professional

Phone

(407) 447-7120

Specialties & licenses 3

Addresses

Other names 1

• CenterWell Senior Primary Care-Jackson East Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Gulfport, MS
  • NPI 1003528092

  O20230315000489

  Same enrollment
• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1821864174

  O20230315000489

  Same enrollment
• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Biloxi, MS
  • NPI 1841902830

  O20230315000489

  Same enrollment

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

CLIA laboratory certificates

Tax ID family

Centerwell Senior Primary5 organizations share this tax ID, including this one

Part of

Centerwell Senior Primary

Other organizations with this tax ID 4

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

• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Gulfport, MS
  • NPI 1003528092
  NPD tax ID
• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1821864174
  NPD tax ID
• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Biloxi, MS
  • NPI 1841902830
  NPD tax ID
• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1891407870
  NPD tax ID

Practitioners 1

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

• Earl Kyle Magee, M.D.

  • Internal Medicine Physician
  • Covington, LA
  • NPI 1508887977
  NPD

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1710693619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168",
            "telephone_number": "305-500-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 E NORTHSIDE DR STE 220",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392115503",
            "telephone_number": "601-298-4173",
            "fax_number": "877-866-2356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE MS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE MS PC",
        "enumeration_date": "2023-01-25",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care-Jackson East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Central Mississippi Civic Improvement Association

• 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 Jul 3, 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.