Active NPI
Lynda Jackson-Assad
- Pediatrics Physician
- Jackson, MS
National Provider Identifier
1790729119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 13035
- Practice address
- 3502 W Northside Dr
Jackson, MS 39213-4454 - Phone
- (601) 362-5321
- Fax
- (601) 364-2600
- NPI assigned
- Jun 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 13035 | MS | Primary |
Addresses
Primary practice location
3502 W Northside Dr
Jackson, MS 39213-4454
Mailing address
3502 W Northside Dr
Jackson, MS 39213-4454
Phone (601) 362-5321
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00115979 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100729000425 | MS | Practitioner - Pediatric Medicine | 9638202567 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Mississippi Civic Improvement Association, Inc. | Past | Accepting new patients |
Interoperability endpoints
- lynda.assad@jhchc.eclinicaldirectplus.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Jackson, MS
- NPI 1134151442
MS
-
- Federally Qualified Health Center (FQHC)
- Jackson, MS
- NPI 1154424554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198108800000",
"number": "1790729119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3502 W NORTHSIDE DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392134454",
"telephone_number": "601-362-5321",
"fax_number": "601-364-2600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3502 W NORTHSIDE DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392134454",
"telephone_number": "601-362-5321",
"fax_number": "601-364-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-ASSAD",
"first_name": "LYNDA",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-15",
"last_updated": "2007-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MS",
"license": "13035",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00115979",
"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 Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.