Janice Bacon, MD
Individual provider Active NPI Pediatrics Physician · Canton, MS
NPI 1750438446 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1750438446
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 10239 (MS)
- Practice address
- 1668 W Peace St
Canton, MS 39046-5332 - Phone
- (601) 859-5213
- Fax
- (601) 859-8771
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- University of Mississippi School of Medicine, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Central Mississippi Health Services, Inc
Practice addresses (Care Compare)
500 W County Line Rd
Tougaloo, MS 39174-9700
Phone (601) 957-6776
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101209000936 | MS | Practitioner - Pediatric Medicine | 9032306709 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Mississippi Health Services, Inc | Current |
Accepting new patients | |
| Central Mississippi Health Services, Inc | Pediatrics | Past | Accepting new patients |
Locations
5429 Robinson Road Ext
Jackson, MS 39204
Phone (601) 914-0163
1134 Winter St
Jackson, MS 39204
Phone (601) 948-5572
500 W County Line Rd
Tougaloo, MS 39174
Phone (601) 956-0131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 10239 | MS | Yes |
Addresses
Primary practice location
1668 W Peace St
Canton, MS 39046-5332
Mailing address
PO Box 588
Canton, MS 39046-0588
Phone (601) 859-5213
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00015416 | Medicaid | MS |
Other providers in Canton, MS
- Angela L. Chandler, M.D., PLLC
- Angelic Hands House Calls
- Ha'Lecia Archie
- Katherine E Arthur
- Ashley D. Hollowell, DMD
- Jessica Bagwell Walker
- Terald Otis Bailey
- Tara Bain
- Gloria Ball
- Kathy A Ball
All providers in Canton, MS · Pediatrics Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.