Cynthia Lufkin Undesser, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

11891 Issued in MS

Practice address

402 Wesley Ave
Jackson, MS 39202-1000

Phone

(601) 360-0583

Fax

(601) 360-0585

NPI assigned

Jan 31, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Forrest County General Hospital

  • Rural Health Clinic/Center
  • Picayune, MS
  • NPI 1043820426
  NPD
• Forrest County General Hospital

  • Psychiatry Physician
  • Hattiesburg, MS
  • NPI 1275710212

  Child & Adolescent Psychiatry

  NPD
• Forrest County General Hospital

  • Psychiatric Hospital Unit
  • Hattiesburg, MS
  • NPI 1295837631
  NPD
• Cares Center Inc

  • Psychiatric Residential Treatment Facility
  • Jackson, MS
  • NPI 1639382690
  NPD (past)
• Harris County Hospital District

  • Clinic Pharmacy
  • Baytown, TX
  • NPI 1184623084
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1841337656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 WESLEY AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021000",
            "telephone_number": "601-360-0583",
            "fax_number": "601-360-0585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 WESLEY AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021000",
            "telephone_number": "601-360-0583",
            "fax_number": "601-360-0585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDESSER",
        "first_name": "CYNTHIA",
        "middle_name": "LUFKIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MS",
            "license": "11891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSURE",
            "identifier": "G5719",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117736",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Taylor Ulmer, DO
• Areejah Umar
• Umc Medical Center
• Aaroneisha Underwood
• Savannah Underwood, D.O.
• Eric Karl Undesser, MD, PHD
• Ricardo Ungo
• Unique Inc
• United Methodist Ministry With Children and Families, Inc.
• Univ OB/GYN Assoc.,PLLC

• Child & Adolescent Psychiatry Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Child & Adolescent Psychiatry Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.