NORTH JACKSON MEDICAL CLINIC PLLC
NPI 1659471407
Internal Medicine in Jackson, MS
About North Jackson Medical Clinic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
NORTH JACKSON MEDICAL CLINIC PLLC (NPI 1659471407) is a healthcare organization registered as an internal medicine in Jackson, Mississippi and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through September 6, 2027 and lists Adesola F Shekoni, Physician, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 10
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
North Jackson Medical Clinic Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by January 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to North Jackson Medical Clinic PLLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
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 25D0964920
North Jackson Medical Clinic PLLC · Jackson, MSFrequently 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 North Jackson Medical Clinic PLLC's NPI number?
The NPI number for North Jackson Medical Clinic PLLC is 1659471407. It was assigned to this organization in the NPPES registry on September 22, 2006.
Where is North Jackson Medical Clinic PLLC located?
North Jackson Medical Clinic PLLC is located at 5160 Galaxie Dr, Jackson, MS 39206. The listed phone number is (601) 713-0890.
What is North Jackson Medical Clinic PLLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is North Jackson Medical Clinic PLLC enrolled in Medicare?
Yes. North Jackson Medical Clinic PLLC is registered in the Medicare PECOS enrollment system.
When is North Jackson Medical Clinic PLLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Mississippi, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through North Jackson Medical Clinic PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to North Jackson Medical Clinic PLLC, in Internal Medicine and Nurse Practitioner. 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. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does North Jackson Medical Clinic PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D0964920) is associated with this NPI, valid through September 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does North Jackson Medical Clinic PLLC accept?
Health plans from Cigna Healthcare list North Jackson Medical Clinic PLLC 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 North Jackson Medical Clinic PLLC was last updated on April 8, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years 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.
# North Jackson Medical Clinic Pllc · NPI 1659471407
Internal Medicine organization in Jackson, Mississippi. Organization record, active in the CMS NPPES registry since September 22, 2006.
## Identity
- **NPI:** 1659471407 (Entity type: Organization)
- **Enumerated:** September 22, 2006
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Adesola Shekoni, PHYSICIAN
## Practice location
- **Address:** 5160 GALAXIE DR, Jackson, MS 39206-4308
- **Phone:** (601) 713-0890 · **Fax:** (601) 366-3415
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Mississippi, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (2), Nurse Practitioner (1); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 8, 2008
- **Other identifiers:** Medicare UPIN G39596 (MS); Other 220338401B (MS); Medicare PIN 110001218 (MS); and 7 more
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1659471407) · Data from the CMS NPPES public registry.