NPIMap

Organization Active NPI

St. Dominic Medical Associates LLC

  • Gastroenterology Physician
  • Jackson, MS
National Provider Identifier
1902374085
Registry record updated Dec 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
ST. DOMINIC MEDICAL ASSOCIATES LLC
Practice address
971 Lakeland Dr Ste 250
Jackson, MS 39216-4620
Phone
(601) 200-5550
Fax
(601) 200-4887
NPI assigned
Nov 7, 2018
Organization subpart
Yes
Parent organization
ST. DOMINIC-JACKSON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

971 Lakeland Dr Ste 250
Jackson, MS 39216-4620

Mailing address

971 Lakeland Dr Ste 250
Jackson, MS 39216-4620
Phone (601) 200-5550

Other names 1

  • St. Dominic Gastroenterology 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
Chemical Dependency Uni

Other organizations with this tax ID 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1541548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671667200000",
    "number": "1902374085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 250",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164620",
            "telephone_number": "601-200-5550",
            "fax_number": "601-200-4887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR STE 250",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164620",
            "telephone_number": "601-200-5550",
            "fax_number": "601-200-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. DOMINIC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. DOMINIC-JACKSON MEMORIAL HOSPITAL",
        "enumeration_date": "2018-11-07",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "601-200-4880"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Dominic Gastroenterology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Dominic Gastroenterology",
            "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 Dec 22, 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.