NPIMap

Organization Active NPI

Jackson Anesthesia Associates PA

  • Anesthesiology Physician
  • Jackson, MS
National Provider Identifier
1780737577
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
JACKSON ANESTHESIA ASSOCIATES PA
Practice address
1151 N State St
Suite 311
Jackson, MS 39202
Phone
(601) 969-1171
Fax
(601) 969-6749
NPI assigned
Jan 18, 2007
Last updated
Nov 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Authorized official

Name
Mrs. Joyce Martin
Title
Credentialing
Phone
(601) 969-1171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

1151 N State St
Suite 311
Jackson, MS 39202

Mailing address

PO Box 22656
Jackson, MS 39225-2656
Phone (888) 502-0531

Other identifiers 1

IdentifierTypeStateIssuer
09013225MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331000285 MS Part B Supplier - Clinic/Group Practice 3870585904 Receives reassigned benefits from 93 practitioners
Practice locations: Flowood, MS; Madison, MS; Jackson, MS

National Provider Directory

National Provider Directory

Locations

1053 River Oaks Dr
#C
Flowood, MS 39232
Phone (601) 969-1430

1151 N State St
Ste 508
Jackson, MS 39202
Phone (601) 948-8293

Practitioners & affiliated clinicians

Practitioners 102

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 102

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1780737577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22656",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392252656",
            "telephone_number": "888-502-0531",
            "fax_number": "601-969-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 N STATE ST",
            "address_2": "SUITE 311",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39202",
            "telephone_number": "601-969-1171",
            "fax_number": "601-969-6749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON ANESTHESIA ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "601-969-1171",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013225",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.