Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

ST. DOMINIC MEDICAL ASSOCIATES LLC
NPI 1407920549
Family Medicine in Jackson, MS

Q: What is St. Dominic Medical Associates LLC's NPI number?

The NPI number for St. Dominic Medical Associates LLC is 1407920549. It was assigned to this organization in the NPPES registry on November 20, 2006.

Q: What is St. Dominic Medical Associates LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since November 20, 2006

969 LAKELAND DR, JACKSON, MS 39216(601) 200-4749(601) 200-5929 Get Directions Write a Review

NPPES record last updated: October 26, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 26, 2026, Nov 18, 2021, Jan 12, 2017 (3 updates tracked since 2017).

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About St. Dominic Medical Associates Llc NPPES

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

ST. DOMINIC MEDICAL ASSOCIATES LLC (NPI 1407920549) is a healthcare organization registered as a family medicine in Jackson, Mississippi and active in the NPI registry since November 2006. The organization lists Samuel Thaddeus Scott, Cfo, as its authorized official.

NPPES Registry Identity

NPI1407920549

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameST. DOMINIC MEDICAL ASSOCIATES LLC

Location Address969 LAKELAND DRJackson, MS 39216-4606

Mailing Address969 Lakeland DrJackson, MS 39216-4606 · (601) 200-2000

Phone(601) 200-4749

Fax(601) 200-5929

Organization SubpartYesParent: St Dominc Jackson Memorial Hospital

Authorized OfficialSamuel Thaddeus ScottCfo · (601) 200-6570

Enumeration DateNovember 20, 2006

Last NPPES UpdateOctober 26, 20263 updates tracked since enumeration

NPPES CertifiedOctober 26, 2026

✔ NPI 1407920549 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 11

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedNeurological SurgeryTaxonomy 207T00000X

Also ListedObstetrics & Gynecology · Gynecologic OncologyTaxonomy 207VX0201X

Also ListedOtolaryngologyTaxonomy 207Y00000X

Also ListedPsychiatry & Neurology · NeurologyTaxonomy 2084N0400X

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X

Also ListedSurgery · Surgical Critical CareTaxonomy 2086S0102X

Also ListedUrologyTaxonomy 208800000X

Also ListedThoracic Surgery (Cardiothoracic Vascular Surgery)Taxonomy 208G00000X

Also ListedPain Medicine · Pain MedicineTaxonomy 208VP0000X

969 LAKELAND DR, Jackson, MS 39216

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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

136

Medicare enrollment records show 136 clinicians reassign Medicare billing to St. Dominic Medical Associates LLC, which bills Medicare for the services they deliver. Of these, 121 practice within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 20

Nurse Practitioner58

Gastroenterology16

Internal Medicine12

Family Practice10

Neurology7

Neurosurgery5

Thoracic Surgery5

Vascular Surgery4

12 other specialties19

Nearest to this location (20)

See all 136

Brittany Boykin, FNP-C

Nurse Practitioner

NPI 1053993865

969 LAKELAND DR
Jackson, MS 39216

(601) 200-5900

✔ PECOS✔ Accepts MedicareSame address

Lauren Caraway, NP-C

Nurse Practitioner

NPI 1821376690

969 LAKELAND DR
Jackson, MS 39216

(601) 200-6712

✔ PECOS✔ Accepts MedicareSame address

Ujjwal Dhar, M.D.

Infectious Disease

NPI 1841223377

969 LAKELAND DR
Jackson, MS 39216

(601) 200-4714

✔ PECOS✔ Accepts MedicareSame address

Teri Dyess, M.D.

Hospitalist

NPI 1235201302

969 LAKELAND DR
Jackson, MS 39216

(601) 200-4644

✔ PECOSSame address

Bobby Graham, M.D.

Hematology/Oncology

NPI 1205831666

969 LAKELAND DR
Jackson, MS 39216

(601) 200-5900

✔ PECOS✔ Accepts MedicareSame address

Kayla Smith, NP-C

Nurse Practitioner

NPI 1215422480

969 LAKELAND DR
Jackson, MS 39216

(601) 200-2280

✔ PECOS✔ Accepts MedicareSame address

Rachael Wilbanks, NPC

Nurse Practitioner

NPI 1134523830

969 LAKELAND DRIVE ST. DOMINIC PALLIATIVE CARE
Jackson, MS 39216

(601) 200-5900

✔ PECOS✔ Accepts MedicareSame address

Kristie Callahan, FNP-C

Nurse Practitioner

NPI 1093129231

971 LAKELAND DR SUITE 557
Jackson, MS 39216

(601) 200-4560

✔ PECOS✔ Accepts Medicare0.1 mi

John Lancon, M.D.

Neurosurgery

NPI 1013008242

971 LAKELAND DR STE 1250
Jackson, MS 39216

(601) 200-5955

✔ PECOS✔ Accepts Medicare0.1 mi

Jennifer Dinning, M.D.

Vascular Surgery

NPI 1699062208

970 LAKELAND DR STE 43
Jackson, MS 39216

(601) 200-2990

✔ PECOS✔ Accepts Medicare0.1 mi

Samuel Love, M.D.

Internal Medicine

NPI 1013273259

970 LAKELAND DR STE 49
Jackson, MS 39216

(601) 200-4850

✔ PECOS✔ Accepts Medicare0.1 mi

Craig Adams, M.D.

Thoracic Surgery

NPI 1114969011

971 LAKELAND DR STE 657
Jackson, MS 39216

(601) 200-2780

✔ PECOS✔ Accepts Medicare0.1 mi

Pierre De Delva, MD

General Surgery

NPI 1043294432

971 LAKELAND DR STE 220
Jackson, MS 39216

(601) 200-2780

✔ PECOS✔ Accepts Medicare0.1 mi

William Fuller, MD

Pulmonary Disease

NPI 1205323177

971 LAKELAND DR STE 1052
Jackson, MS 39216

(601) 981-9503

✔ PECOS✔ Accepts Medicare0.1 mi

David Mchenry, MD

Neurology

NPI 1053494831

971 LAKELAND DRIVE SUITE 557
Jackson, MS 39216

(601) 200-4560

✔ PECOS✔ Accepts Medicare0.1 mi

Jared Taylor, M.D.

Psychiatry

NPI 1154686541

969 LAKELAND DR
Jackson, MS 39216

(601) 200-5790

✔ PECOS✔ Accepts Medicare0.1 mi

Ronald Davis, M.D.

Urology

NPI 1255351367

971 LAKELAND DR SUITE 360
Jackson, MS 39216

(601) 200-4370

✔ PECOS✔ Accepts Medicare0.1 mi

Anne Mcpherson, M.D

Infectious Disease

NPI 1689622318

971 LAKELAND DR STE 954
Jackson, MS 39216

(601) 200-4714

✔ PECOS0.1 mi

Donald Seago, MD

Gynecological Oncology

NPI 1194717363

971 LAKELAND DR STE 750
Jackson, MS 39216

(601) 987-3033

✔ PECOS✔ Accepts Medicare0.1 mi

Mark Wilson, MD

Gastroenterology

NPI 1184612368

971 LAKELAND DR STE 250
Jackson, MS 39216

(601) 200-5550

✔ PECOS✔ Accepts Medicare0.1 mi

See all 136 clinicians

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

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 St. Dominic Medical Associates LLC's NPI number?

The NPI number for St. Dominic Medical Associates LLC is 1407920549. It was assigned to this organization in the NPPES registry on November 20, 2006.

Where is St. Dominic Medical Associates LLC located?

St. Dominic Medical Associates LLC is located at 969 Lakeland Dr, Jackson, MS 39216. The listed phone number is (601) 200-4749.

What is St. Dominic Medical Associates LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is St. Dominic Medical Associates LLC enrolled in Medicare?

Yes. St. Dominic Medical Associates LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through St. Dominic Medical Associates LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 136 clinicians in 20 Medicare specialties reassign their Medicare billing to St. Dominic Medical Associates 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. The largest specialties are Nurse Practitioner (58), Gastroenterology (16) and Internal Medicine (12). Of these, 121 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does St. Dominic Medical Associates LLC accept?

Health plans from Molina Healthcare list St. Dominic Medical Associates LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for St. Dominic Medical Associates LLC was last updated on October 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 days 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.