NPIMap

Individual provider Active NPI

Matthew Edward Flynn, FNP, ACNP

  • Acute Care Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1760618292
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R860587 Issued in MS
Practice address
971 Lakeland Dr Ste 1052
Jackson, MS 39216-4609
Phone
(601) 981-9503
Fax
(601) 982-1198
NPI assigned
Jun 10, 2009
Last updated
Oct 10, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R860587 MS Primary
Family Nurse Practitioner 363LF0000X R860587 MS

Addresses

Primary practice location

971 Lakeland Dr Ste 1052
Jackson, MS 39216-4609

Mailing address

971 Lakeland Dr Ste 1052
Jackson, MS 39216-4609
Phone (601) 981-9503

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090929000516 MS Practitioner - Nurse Practitioner 5698811982 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Pulmonary Associates, PAGroup PAC ID 7517934292, 33 clinicians

Practice addresses (Care Compare)

971 Lakeland Dr
Suite 1052
Jackson, MS 39216-4609
Phone (601) 981-9503

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince May 1, 2014 Accepting new patients
Forrest County General Hospital CurrentSince Feb 1, 2020 Accepting new patients
Simpson Community Healthcare, Inc. Current Accepting new patients
Jackson Pulmonary Associates, PA CurrentSince Aug 1, 2011 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Independent Healthcare Management, Inc. CurrentSince May 1, 2016 Accepting new patients
Forrest County General Hospital CurrentSince Feb 1, 2020 Accepting new patients
Simpson Community Healthcare, Inc CurrentSince May 1, 2018 Accepting new patients
Simpson Community Healthcare Inc. CurrentSince May 1, 2018 Accepting new patients
Independent Healthcare Management, Inc. CurrentSince May 1, 2016 Accepting new patients
Pearl River County Hospital CurrentSince May 1, 2014 Accepting new patients
Gulfport Emergency Physicians Past Accepting new patients

Locations

330 N Broad St
Forest, MS 39074
Phone (601) 469-4151

330 N Broad St
#S
Forest, MS 39074
Phone (601) 469-4151

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

501 Marshall St
Ste 200
Jackson, MS 39202
Phone (601) 354-8895

971 Lakeland Dr
Ste 1052
Jackson, MS 39216
Phone (601) 981-9503

1842 Simpson Highway 149
Mendenhall, MS 39114
Phone (601) 847-2221

305 W Moody St
Poplarville, MS 39470
Phone (601) 795-4345

305 W Moody St
#H
Poplarville, MS 39470
Phone (601) 795-4345

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.323

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1760618292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 1052",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164609",
            "telephone_number": "601-981-9503",
            "fax_number": "601-982-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 1052",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164609",
            "telephone_number": "601-981-9503",
            "fax_number": "601-982-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYNN",
        "first_name": "MATTHEW",
        "middle_name": "EDWARD",
        "credential": "FNP, ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-10",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R860587",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R860587",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.