Medserve, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

12503 Issued in MS

Legal business name

MEDSERVE, PA

Practice address

Manhattan Nursing and Rehabilitation Center
4540 Manhattan Rd
Jackson, MS 39206

Phone

(601) 206-0901

Fax

(888) 240-6288

NPI assigned

Apr 19, 2011

Last updated

Jan 13, 2022By 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

Todd L Fulcher, MD, CMDNPI 1124097191

Title

Physician, Owner

Phone

(601) 206-0901

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 7

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.

• Todd L Fulcher, MD

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1124097191
  Medicare reassignment Care Compare group NPD Authorized official
• Bethany Anna Free, FNP- BC

  • Family Nurse Practitioner
  • Houston, MS
  • NPI 1235736778

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Jordan Larue Fulcher Jenkins, FNP-C

  • Family Nurse Practitioner
  • Madison, MS
  • NPI 1922577378
  Medicare reassignment Care Compare group NPD
• Amy Chapman Johnson, FNP-BC

  • Family Nurse Practitioner
  • Lexington, MS
  • NPI 1770864381
  Medicare reassignment Care Compare group NPD
• Daphenia C. Knight Starling, ANP

  • Adult Health Nurse Practitioner
  • Clinton, MS
  • NPI 1922394469
  Medicare reassignment Care Compare group NPD
• Sara Aileen Knight, FNP

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1083852131
  Medicare reassignment Care Compare group NPD
• Sueanne Davidson, NP

  • Nurse Practitioner
  • Aliceville, AL
  • NPI 1508806308

  MS

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642032000000",
    "number": "1871883223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 AMITY LN",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "39047",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MANHATTAN NURSING AND REHABILITATION CENTER",
            "address_2": "4540 MANHATTAN RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39206",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Clinton Healthcare",
            "address_2": "1251 Pinehaven Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MS",
            "postal_code": "39056",
            "country_code": "US",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Aurora Health and Rehabilitation",
            "address_2": "310 Emerald Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "MS",
            "postal_code": "39702",
            "country_code": "US",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Compere's Nursing Home",
            "address_2": "865 North St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "39202",
            "country_code": "US",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Magnolia Senior Care",
            "address_2": "3701 Peter Quinn Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "39213",
            "country_code": "US",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Lexington Manor Nursing Home",
            "address_2": "56 Rockport Rd",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "MS",
            "postal_code": "39095",
            "country_code": "US",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDSERVE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-19",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A",
        "authorized_official_last_name": "FULCHER",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN, OWNER",
        "authorized_official_telephone_number": "601-206-0901",
        "authorized_official_credential": "MD, CMD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "12503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05675311",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Medical Mall Health Services, LLC (Medical Mall Health Services of Jackson)
• Medical Mall Services of Mississippi, LLC (Medical Mall Health Services)
• Medical Mall Vision Clinic
• Medicomp, Inc (Medicomp Physical Therapy Jackson)
• Medigo LLC
• Medsmart LLC
• Sara Beth Meek, MSN, NP-C
• George Rodney Meeks, M.D.
• Melonise Meeks
• William M. Meeks, MD

• Family Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 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.