Lara J Teal Clement, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

16858 Issued in MS

Practice address

Magnolia Senior Care
3701 Peter Quinn Dr
Jackson, MS 39213

Phone

(601) 206-0901

Fax

(888) 240-6288

NPI assigned

Jun 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Biloxi, MS
  • NPI 1841902830

  Family Medicine

  Medicare reassignment NPD
• Centerwell Senior Primary Care Ms PC

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1821864174

  Family Medicine

  NPD
• Vicksburg Clinic LLC

  • Infectious Disease Physician
  • Vicksburg, MS
  • NPI 1659307791

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1912933672",
    "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": "390477941",
            "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": "MAGNOLIA SENIOR CARE",
            "address_2": "3701 PETER QUINN DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39213",
            "telephone_number": "601-206-0901",
            "fax_number": "888-240-6288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEAL CLEMENT",
        "first_name": "LARA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "16858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122664",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Travis Jackson Taylor, DDS
• Muhammad Tayyab
• Natalia Tcacenco
• Vladimir Tchikrizov
• Clint Teague, M.D.
• Team 82 Physical Therapy
• Jennifer L Teasley
• Telehealthone, LLC
• Telemedicine Services of Mississippi
• Regan Layne Temple, FNP-C

• 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 May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.