Executive Outcomes PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EXECUTIVE OUTCOMES PC

Practice address

379 Hospital Blvd
Jackson, TN 38305-2080

Phone

(731) 661-6330

NPI assigned

Jun 25, 2012

Last updated

Aug 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Monico P Banez, MDNPI 1962479451

Title

Owner

Phone

(731) 234-5717

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 3

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.

• Monico Peter Banez, MD

  • Hospitalist Physician
  • Jackson, TN
  • NPI 1962479451

  Internal Medicine

  Medicare reassignment NPD Authorized official
• Maria Caroline Antique, M.D.

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1245278415
  Medicare reassignment NPD
• Jay Gordon Shires, MD

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1093988008
  NPD (past)

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755129600000",
    "number": "1821352808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11355",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383080122",
            "telephone_number": "731-234-5717",
            "fax_number": "423-979-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 HOSPITAL BLVD",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052080",
            "telephone_number": "731-661-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE OUTCOMES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A",
        "authorized_official_last_name": "BANEZ",
        "authorized_official_first_name": "MONICO",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-234-5717",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cara Evans, PTA
• Caroline Evans, SLP
• Sylvia J Evans, CRNA
• John E Everett, MD
• Executive Level Wellness
• Extendicare of West Tenn
• Extendicare of West TN
• Eye Care Group, PLLC
• Eyemart Express LLC
• Eze Clinic P.C.

• Internal Medicine Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; 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.