NPIMap

Organization Active NPI

St Dominic Medical Associates LLC

Doing business as Cardiovascular Surgery Associates

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Jackson, MS
National Provider Identifier
1831342054
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
ST DOMINIC MEDICAL ASSOCIATES LLC
Doing business as
Cardiovascular Surgery Associates
Practice address
970 Lakeland Dr Ste 61
Jackson, MS 39216-4634
Phone
(601) 200-2780
Fax
(601) 200-2788
NPI assigned
Oct 31, 2008
Last updated
Jun 16, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. DOMINIC JACKSON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Authorized official

Name
Danielle Stuart
Title
Credentialing Representative 2
Phone
(601) 200-4880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X NU Primary

Addresses

Primary practice location

970 Lakeland Dr Ste 61
Jackson, MS 39216-4634

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-2780

Other practice location 1

971 Lakeland Dr Ste 657
Jackson, MS 39216-4608
Phone (601) 200-2990

Other practice location 2

610 Second St
Pelahatchie, MS 39145-3135
Phone (601) 854-5044

Other practice location 3

360 Simpson Highway 149 Ste 370
Magee, MS 39111-3843
Phone (601) 200-2780

Other practice location 4

332 Highway 12 W
Kosciusko, MS 39090-3209
Phone (601) 200-2780

Other practice location 5

4204 Clay St
Vicksburg, MS 39183-3438
Phone (601) 200-2780

Other practice location 6

810 E Sunflower Rd Ste 100J
Cleveland, MS 38732-2828
Phone (601) 200-2780

Other identifiers 1

IdentifierTypeStateIssuer
00978789MedicaidMS

Other names 1

  • Cardiovascular Surgery Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090728000821 MS Part B Supplier - Clinic/Group Practice 0446303168 Receives reassigned benefits from 143 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, MS; Madison, MS; Jackson, MS; Flowood, MS; Clinton, MS; Brandon, MS

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
St Dominic Medical Associates LLC28 organizations share this tax ID, including this one
Part of
Jackson Mental Health

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Locations

810 E Sunflower Rd
Ste 100J
Cleveland, MS 38732
Phone (601) 200-4560

728 Clinton Pkwy
#B
Clinton, MS 39056
Phone (601) 200-4800

970 Lakeland Dr
Ste 43
Jackson, MS 39216
Phone (601) 200-4880

971 Lakeland Dr
Ste 657
Jackson, MS 39216
Phone (601) 200-2780

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623801600000",
    "number": "1831342054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 LAKELAND DR STE 61",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164634",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "971 Lakeland Dr Ste 657",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164608",
            "country_code": "US",
            "telephone_number": "601-200-2990",
            "fax_number": "601-200-5939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 Second St",
            "address_purpose": "LOCATION",
            "city": "Pelahatchie",
            "state": "MS",
            "postal_code": "391453135",
            "country_code": "US",
            "telephone_number": "601-854-5044",
            "fax_number": "601-854-8448",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 Simpson Highway 149 Ste 370",
            "address_purpose": "LOCATION",
            "city": "Magee",
            "state": "MS",
            "postal_code": "391113843",
            "country_code": "US",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "332 Highway 12 W",
            "address_purpose": "LOCATION",
            "city": "Kosciusko",
            "state": "MS",
            "postal_code": "390903209",
            "country_code": "US",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4204 Clay St",
            "address_purpose": "LOCATION",
            "city": "Vicksburg",
            "state": "MS",
            "postal_code": "391833438",
            "country_code": "US",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "810 E Sunflower Rd Ste 100J",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "MS",
            "postal_code": "387322828",
            "country_code": "US",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST DOMINIC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. DOMINIC JACKSON MEMORIAL HOSPITAL",
        "enumeration_date": "2008-10-31",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CREDENTIALING REPRESENTATIVE 2",
        "authorized_official_telephone_number": "601-200-4880"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00978789",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiovascular Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cardiovascular Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 16, 2021; 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.