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JOURNEYCARE MEDICAL, LLC
NPI 1245170885
Nurse Practitioner - Primary Care in Jackson, MS

Active since April 01, 2026CLIA 25D2345533 · Waiver
350 W WOODROW WILSON AVE STE 1010, JACKSON, MS 39213(601) 376-8019 Get Directions Write a Review

NPPES record last updated: April 22, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 22, 2026, Apr 1, 2026 (2 updates tracked since 2026).

About Journeycare Medical, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOURNEYCARE MEDICAL, LLC (NPI 1245170885) is a healthcare organization registered as a primary care in Jackson, Mississippi and active in the NPI registry since April 2026. The organization holds a CLIA Waiver certificate valid through June 10, 2028 and lists Shantrice Bernice Nichols-bates, Ceo/medical Director, as its authorized official.

NPPES Registry Identity

NPI1245170885
Entity TypeOrganization
Primary Taxonomy363LP2300X
Legal Business NameJOURNEYCARE MEDICAL, LLC
Location Address350 W WOODROW WILSON AVE STE 1010Jackson, MS 39213-7681
Mailing Address123a Highway 80 E, Pmb# 140Clinton, MS 39056-4738 · (769) 366-2659
Phone(601) 376-8019
Organization SubpartNo
Authorized OfficialShantrice Bernice Nichols-batesCeo/medical Director · (769) 366-2659
Enumeration DateApril 1, 2026
Last NPPES UpdateApril 22, 20262 updates tracked since enumeration
NPPES CertifiedApril 22, 2026
✔ NPI 1245170885 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
350 W WOODROW WILSON AVE STE 1010, Jackson, MS 39213
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Journeycare Medical, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Journeycare Medical, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Shantrice Nichols-Bates, DNP, FNP-C
Nurse Practitioner
NPI 1245603844
350 W WOODROW WILSON AVE STE 1010
Jackson, MS 39213
(769) 366-4719
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2345533

Journeycare Medical, LLC · Jackson, MS
Active · expires Jun 10, 2028
CLIA Number25D2345533
Laboratory TypePractitioner Other
Certificate Effective DateJune 11, 2026
Certificate Expiration DateJune 10, 2028
Laboratory DirectorShantrice B. Nichols-Bates
Laboratory Phone(769) 366-2659
Laboratory LocationJourneycare Medical, LLC350 W Woodrow Wilson Ave, Ste 1010, Jackson, MS 39213
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Journeycare Medical, LLC's NPI number?

The NPI number for Journeycare Medical, LLC is 1245170885. It was assigned to this organization in the NPPES registry on April 1, 2026.

Where is Journeycare Medical, LLC located?

Journeycare Medical, LLC is located at 350 W Woodrow Wilson Ave Ste 1010, Jackson, MS 39213. The listed phone number is (601) 376-8019.

What is Journeycare Medical, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Journeycare Medical, LLC enrolled in Medicare?

Yes. Journeycare Medical, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Journeycare Medical, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Journeycare Medical, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Journeycare Medical, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2345533) is associated with this NPI, valid through June 10, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Journeycare Medical, LLC was last updated on April 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.