NPIMap

Individual provider Active NPI

Shannon J. Myers, MD

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1881958288
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
829-L Issued in MS
Practice address
878 Lakeland Dr
Jackson, MS 39216-4644
Phone
(601) 984-6800
Fax
(601) 984-6811
NPI assigned
Jun 29, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 829-L MS Primary

Addresses

Primary practice location

878 Lakeland Dr
Jackson, MS 39216-4644

Mailing address

PO Box 4999
Jackson, MS 39296-4999
Phone (601) 984-5426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151016001340 MS Practitioner - Family Practice 0143539908 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Sunflower Medical CenterGroup PAC ID 7618932294, shared by 11 NPIs, 46 clinicians

Practice addresses (Care Compare)

202 S Ruby Ave
Ruleville, MS 38771-3227
Phone (662) 756-2500

840 N Oak Ave
Ruleville, MS 38771-3227

860 N Oak Ave
Ruleville, MS 38771-3227

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
829-LMSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Sunflower Medical Center Family Medicine Current Accepting new patients
Delta Medical Group Family Medicine CurrentSince May 12, 2018 Accepting new patients
North Sunflower Medical Center Current Accepting new patients
North Sunflower Medical Center CurrentSince Jul 28, 2015 Accepting new patients
Nexion Health at Greenwood, Inc. Past Accepting new patients
Delta Physician Practices Past Accepting new patients
Delta Health System Past Accepting new patients
Dac of Shelby, LLC Past Accepting new patients
Mississippi Commcare Corporation a Non Profit Corporation Past Accepting new patients
North Sunflower Medical Center Past Accepting new patients

Locations

1693 Fairgrounds Rd
Greenville, MS 38703
Phone (662) 378-3783

300 S Washington Ave
Greenville, MS 38701
Phone (662) 378-2020

860 N Oak Ave
Ruleville, MS 38771
Phone (662) 756-2711

840 N Oak Ave
Ruleville, MS 38771
Phone (601) 756-2711

Interoperability endpoints

  • Direct secure messaging: cuf5147@yourcarecommunity.org
  • Direct secure messaging: shannonmyers@nsfmc.allscriptsdirect.net

Organizations & group practices 10

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.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1881958288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4999",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392964999",
            "telephone_number": "601-984-5426",
            "fax_number": "601-984-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "878 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164644",
            "telephone_number": "601-984-6800",
            "fax_number": "601-984-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "SHANNON",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "829-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.