ST. DOMINIC JACKSON MEMORIAL
NPI 1235173691
Emergency Medicine in Jackson, MS
NPI Status: Active since June 16, 2006
Contact Information
969 LAKELAND DR
JACKSON, MS
ZIP 39216
Phone: (601) 200-2000
- Organization
- Emergency Medicine
- Accepts Insurance
About ST. DOMINIC JACKSON MEMORIAL
This page provides the complete NPI Profile along with additional information for St. Dominic Jackson Memorial, a provider established in Jackson, Mississippi operating as a Emergency Medicine. The healthcare provider is registered in the NPI registry with number 1235173691 assigned on June 2006. The practitioner's primary taxonomy code is 207P00000X. The provider is registered as an organization and their NPI record was last updated 15 years ago. St. Dominic Jackson Memorial operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's former legal business name is St Dominic Emergency Room. The authorized official of this NPI record is Karl Hatten M.d. (Director)
- NPI
- 1235173691
- Provider Legal Name
- ST. DOMINIC JACKSON MEMORIAL
- Other Organization Name
- ST DOMINIC EMERGENCY ROOM
- Other Name Type
- Former Legal Business Name (4)
- Entity Type
- Organization
- Location Address
- 969 LAKELAND DR JACKSON, MS 39216
- Location Phone
- (601) 200-2000
- Mailing Address
- 969 LAKELAND DR JACKSON, MS 39216
- Mailing Phone
- (601) 200-2000
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-16-2006
- Last Update Date
- 08-11-2010
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Emergency Medicine
- Taxonomy Code
- 207P00000X
- Type
- Allopathic & Osteopathic Physicians
- License State
- MS
- Taxonomy Description
- An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | (MS) |
| 2 | 208600000X | Allopathic & Osteopathic Physicians | Surgery | (MS) |
| 3 | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | (MS) |
| 4 | 367H00000X | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant | (MS) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Choice Bronze HSA (QualChoice) - POS
- Complete Gold - PPO
- Complete Gold + Vision + Adult Dental - PPO
- Complete Silver (QualChoice) - POS
- Connected Silver - PPO
- Connected Silver (QualChoice) - POS
- Connected Silver (QualChoiceLife) - PPO
- Connected Silver + Vision + Adult Dental - PPO
- Elite Bronze - PPO
- Elite Bronze + Vision + Adult Dental - PPO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Choice Bronze HSA - HMO
- Choice Bronze HSA + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete Silver - HMO
- Complete Silver + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Everyday Gold + Vision + Adult Dental - HMO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Elite Silver - EPO
- Elite Silver + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Clear Silver - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- Everyday Gold - EPO
- Blue HSA Bronze - PPO
- Blue Protect - PPO
- Blue Saver Bronze - PPO
- Blue Value Gold - PPO
- Blue Value Silver - PPO
- Blue Access Gold for Business - PPO
- Blue Choice Platinum for Business - PPO
- Blue HSA Silver for Business - PPO
- Blue Saver Bronze for Business - PPO
- Blue Saver Gold for Business - PPO
- Bronze 4 - HMO
- Bronze 8 - HMO
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 8 - HMO
- Silver 1 - HMO
- Silver 1 with Adult Vision Services - HMO
- Silver 12 with First 4 Primary Care Visits Free - HMO
- Silver 8 - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 09014778 | MEDICAID (05) | MS | |
| C02387 | MEDICARE PIN (08) | MS |
Reviews for ST. DOMINIC JACKSON MEMORIAL
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 3 | 5 | 1 | 7 | 3 | 6 | 9 | 1 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 6 | 5 | 2 | 7 | 6 | 6 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 6 + 5 + 2 + 7 + 6 + 6 + 1 + 8 + 24 = 69 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 69 = 1 | 1 | ||||||||
The NPI number 1235173691 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
JOSEPH N CANDELORA M.D.
Pathology
(Anatomic Pathology & Clinical Pathology)
969 LAKELAND DR
JACKSON, MS
ZIP 39216
DIANA MINASIAN STULC M.D.
Family Medicine
969 LAKELAND DR
JACKSON, MS
ZIP 39216
REGENCY HOSPITAL OF JACKSON, LLC
Long Term Care Hospital
969 LAKELAND DR
6TH FLOOR
JACKSON, MS
ZIP 39216
COGENT HEALTHCARE OF JACKSON MS, LLC
Internal Medicine
969 LAKELAND DR
JACKSON, MS
ZIP 39216
MARSHALL JAMES STOUT M.D.
Emergency Medicine
969 LAKELAND DR
JACKSON, MS
ZIP 39216
DANARIUS WILLIAMS MD
Emergency Medicine
969 LAKELAND DR
JACKSON, MS
ZIP 39216
RICHARD H FLOWERS III MD
Internal Medicine
(Infectious Disease)
969 LAKELAND DR
JACKSON, MS
ZIP 39216
DR. WILLIAM DOUGLAS ROUTH MD
Radiology
(Diagnostic Radiology)
969 LAKELAND DR
JACKSON, MS
ZIP 39216
JULIE VANSICE CFNP, PMHNP
Nurse Practitioner
(Psychiatric/Mental Health)
969 LAKELAND DR
ST. THOMAS HALL
JACKSON, MS
ZIP 39216
WILLIAM C LOTT PH.D.
Psychologist
(Clinical)
969 LAKELAND DR
ST THOMAS HALL
JACKSON, MS
ZIP 39216
JEAN A BOUDREAUX PHD
Psychologist
969 LAKELAND DR
JACKSON, MS
ZIP 39216
NEHA BANSI SHAH MD
Hospitalist
969 LAKELAND DR
JACKSON, MS
ZIP 39216
MRS. BEVERLY EAVES OLIVER N.P.
Nurse Practitioner
(Family)
969 LAKELAND DR
JACKSON, MS
ZIP 39216
ST. DOMINIC MEDICAL ASSOCIATES INC
Psychiatry & Neurology
(Psychiatry)
969 LAKELAND DR
ST THOMAS HALL
JACKSON, MS
ZIP 39216
ST DOMINIC HOSPITAL CRNA'S
Nurse Anesthetist, Certified Registered
969 LAKELAND DR
JACKSON, MS
ZIP 39216
ROBERT BARR CRNA
Nurse Anesthetist, Certified Registered
969 LAKELAND DR
JACKSON, MS
ZIP 39216
STEPHEN D JOHNSON FNP
Nurse Practitioner
(Family)
969 LAKELAND DR
JACKSON, MS
ZIP 39216
MRS. ANGELA LOUISE DILWORTH
Specialist/Technologist, Pathology
(Medical Technologist)
969 LAKELAND DR
JACKSON, MS
ZIP 39216
ST. DOMINIC MEDICAL ASSOCIATES, LLC
Psychiatry & Neurology
(Neurology)
969 LAKELAND DR
JACKSON, MS
ZIP 39216
DUSTIN BENGE CRNA
Nurse Anesthetist, Certified Registered
969 LAKELAND DR
JACKSON, MS
ZIP 39216
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1235173691, enumerated as an "organization" on June 16, 2006.
The provider is located at 969 LAKELAND DR JACKSON, MS 39216 and the phone number is (601) 200-2000.
Emergency Medicine with taxonomy code 207P00000X.
The provider might be accepting Accepts: Ambetter from Arkansas Health & Wellness, Ambetter. Please consult your insurance carrier or call the provider to verify.
