Prentiss Primary Care, P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

15442 Issued in MS

Legal business name

PRENTISS PRIMARY CARE, P.A.

Practice address

959 Hwy 42
Prentiss, MS 39474-1373

Phone

(601) 792-3200

Fax

(601) 792-3299

NPI assigned

Mar 11, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Jaishankar Jagadeesan, MDNPI 1326149253

Title

President

Phone

(601) 792-3200

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13169/brand/1/csg/1/fhir/r4

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaishankar Jagadeesan, MD

  • Internal Medicine Physician
  • Prentiss, MS
  • NPI 1326149253

  Internal Medicine, MS

  Medicare reassignment NPD Authorized official
• Adrianne Cronin Kelley, ANP-C

  • Acute Care Nurse Practitioner
  • Jackson, MS
  • NPI 1952661498
  NPD (past)
• Debra B. Taylor, FNP

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1326165218
  NPD (past)

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1902129455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1373",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "394741373",
            "telephone_number": "601-792-3200",
            "fax_number": "601-792-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 HWY 42",
            "city": "PRENTISS",
            "state": "MS",
            "postal_code": "394741373",
            "telephone_number": "601-792-3200",
            "fax_number": "601-792-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRENTISS PRIMARY CARE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "JAGADEESAN",
        "authorized_official_first_name": "JAISHANKAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-792-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "15442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016230",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00118344",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Morris, CFNP
• Nfinity Innovative Solutions LLC
• Nfinity Private Duty Home Health LLC
• Angela Marice Perkins, FNP-C
• Edrice Polk, LPC
• Prentiss Regional Hospital and Ecf, Inc.
• Prentiss Regional Hospital and Ecf, Inc.
• Prentiss Regional Hospital and Ecf, Inc.
• Prentiss Regional Hospital and Ecf, Inc.
• Prentiss Regional Hospital and Extended Care Facility, Inc.

• All providers in Prentiss, MS
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; 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.