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CENTERWELL SENIOR PRIMARY CARE-JACKSON EAST
NPI 1710693619
Internal Medicine in Jackson, MS

Active since January 25, 2023CLIA 25D2278595 · Waiver
1220 E NORTHSIDE DR STE 220, JACKSON, MS 39211(601) 298-4173(877) 866-2356 Get Directions Write a Review

NPPES record last updated: July 3, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 3, 2024, Aug 11, 2023, Feb 23, 2023 and 1 more (4 updates tracked since 2023).

About Centerwell Senior Primary Care-jackson East NPPES

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

CENTERWELL SENIOR PRIMARY CARE-JACKSON EAST (NPI 1710693619) is a healthcare organization registered as an internal medicine in Jackson, Mississippi and active in the NPI registry since January 2023. The organization holds a CLIA Waiver certificate valid through March 20, 2027 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1710693619
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE MS PC
Location Address1220 E NORTHSIDE DR STE 220Jackson, MS 39211-5503
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000
Phone(601) 298-4173
Fax(877) 866-2356
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateJanuary 25, 2023
Last NPPES UpdateJuly 3, 20244 updates tracked since enumeration
NPPES CertifiedJuly 3, 2024
✔ NPI 1710693619 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedGeneral PracticeTaxonomy 208D00000X
1220 E NORTHSIDE DR STE 220, Jackson, MS 39211
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Other Names 1

Doing Business AsCenterwell Senior Primary Care-jackson East

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

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 25D2278595

Centerwell Senior Primary Care-Jackson East · Jackson, MS
Active · expires Mar 20, 2027
CLIA Number25D2278595
Laboratory TypePhysician Office
Certificate Effective DateMarch 21, 2025
Certificate Expiration DateMarch 20, 2027
Laboratory DirectorDr. Earl K. Magee
Laboratory Phone(601) 298-4173
Laboratory LocationCenterwell Senior Primary Care-Jackson East1220 E Northside Dr Ste 220, Jackson, MS 39211
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASHLEY TRUSSELL CROOM NP
Nurse Practitioner
1220 E NORTHSIDE DR STE 220
JACKSON, MS 39211
Hinds County (601) 298-4173
ERIKA DIONNE REDD NP-C
Nurse Practitioner
1220 E NORTHSIDE DR STE 220
JACKSON, MS 39211
Hinds County (601) 298-4173

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 Centerwell Senior Primary Care Ms PC's NPI number?

The NPI number for Centerwell Senior Primary Care Ms PC is 1710693619. It was assigned to this organization in the NPPES registry on January 25, 2023. The provider is doing business as Centerwell Senior Primary Care-Jackson East.

Where is Centerwell Senior Primary Care Ms PC located?

Centerwell Senior Primary Care Ms PC is located at 1220 E Northside Dr Ste 220, Jackson, MS 39211. The listed phone number is (601) 298-4173.

What is Centerwell Senior Primary Care Ms PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Centerwell Senior Primary Care Ms PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2278595) is associated with this NPI, valid through March 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Centerwell Senior Primary Care Ms PC was last updated on July 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.