Jackson Heart and Vascular Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

JACKSON HEART AND VASCULAR CENTER LLC

Practice address

185 Medical Pkwy Ste 101
Flowood, MS 39232-1230

Phone

(405) 285-7500

NPI assigned

Jan 11, 2023

Organization subpart

No

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

Authorized official

Name

Casey McMahan

Title

Manager

Phone

(405) 285-7500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Listed as

Jackson Heart and Vascular Center LLCCCN 25C0001104

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 1

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

• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689292800000",
    "number": "1760196984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 MEDICAL PKWY STE 101",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392321230",
            "telephone_number": "601-414-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 MEDICAL PKWY STE 101",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392321230",
            "telephone_number": "405-285-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON HEART AND VASCULAR CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A",
        "authorized_official_last_name": "MCMAHAN",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "405-285-7500"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Dental Care, PLLC
• Kimyuana Jackson Dorris, PMHNP, AGNP-C
• Jackson Ear Clinic PA
• Jackson Emergency Associates LLC
• Jackson Healthcare for Women PA
• Jackson Imaging
• Jackson Neurosurgery Clinic, PLLC
• Angela Allen Jackson, NP-C
• Carly Jane Jackson, PA
• Cress Schammel Jacobs, PA-C

• Ambulatory Surgical Clinic/Center in Flowood, MS
• Providers in Flowood, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; 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.