Individual provider Active NPI

Lydia Jane Dungan, CRNP

  • Acute Care Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1912367939
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
905545 Issued in MS
Practice address
501 Marshall St Ste 104
Jackson, MS 39202-1663
Phone
(601) 969-6404
Fax
(601) 973-4541
NPI assigned
Mar 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1-134689 AL
Acute Care Nurse Practitioner 363LA2100X 905545 MS Primary

Addresses

Primary practice location

501 Marshall St Ste 104
Jackson, MS 39202-1663

Mailing address

965 Ridge Lake Blvd Ste 315
Memphis, TN 38120-9401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221031002609 MS Practitioner - Nurse Practitioner 9931490638 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1225 N State St
Jackson, MS 39202-2064
Phone (601) 292-4261

151 E Metro Dr
Flowood, MS 39232-4405

151 E Metro Pkwy
Suite 201
Flowood, MS 39232-4405
Phone (601) 973-1680

401 Baptist Dr
Suite 104
Madison, MS 39110-2010
Phone (601) 973-1504

501 Marshall St
Suite 104
Jackson, MS 39202-1663
Phone (601) 969-6404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.38 of 100Reported as group
Quality
54.22
Promoting interoperability
100
Improvement activities
40
Cost
73.72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-134689ALMDAcute Care Nurse Practitioner
905545MSMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Foundation of Central Mississippi, Inc. CurrentSince Sep 4, 2022 Accepting new patients
Mississippi Baptist Medical Center, Inc CurrentSince Sep 4, 2022 Accepting new patients
Mississippi Baptist Medical Center, Inc. Current Accepting new patients
Mississippi Baptist Medical Center, Inc. CurrentSince Sep 4, 2022 Accepting new patients
Medical Foundation of Central Ms CurrentSince Sep 4, 2022 Accepting new patients

Locations

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

501 Marshall St
Ste 104
Jackson, MS 39202
Phone (601) 973-4541

401 Baptist Dr
Ste 104
Madison, MS 39110
Phone (601) 605-2383

965 Ridge Lake Blvd
Ste 315
Memphis, TN 38120
Phone (877) 348-1281

Organizations & group practices 5

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1912367939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 315",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST STE 104",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021663",
            "telephone_number": "601-969-6404",
            "fax_number": "601-973-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNGAN",
        "first_name": "LYDIA",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-03",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-134689",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "905545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.