CENTERWELL SENIOR PRIMARY CARE-JACKSON EAST
NPI 1710693619
Internal Medicine in Jackson, MS
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
Specialties & Licenses 3
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Centerwell Senior Primary Care-jackson East is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
27Medicare enrollment records show 27 clinicians reassign Medicare billing to Centerwell Senior Primary Care-Jackson East, which bills Medicare for the services they deliver. Of these, 4 practice within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 4
Nearest to this location (20)
See all 27Source: 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 25D2278595
Centerwell Senior Primary Care-Jackson East · 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 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.
Is Centerwell Senior Primary Care Ms PC enrolled in Medicare?
Yes. Centerwell Senior Primary Care Ms PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Centerwell Senior Primary Care Ms PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 27 clinicians in 4 Medicare specialties reassign their Medicare billing to Centerwell Senior Primary Care Ms PC. 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 (11), Cardiovascular Disease (Cardiology) (9) and Family Practice (6). Of these, 4 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
# Centerwell Senior Primary Care-Jackson East · NPI 1710693619
Internal Medicine organization in Jackson, Mississippi. Organization record, active in the CMS NPPES registry since January 25, 2023.
## Identity
- **NPI:** 1710693619 (Entity type: Organization)
- **Enumerated:** January 25, 2023
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Legal business name:** Centerwell Senior Primary Care Ms Pc
- **Organization subpart:** Yes (part of Centerwell Senior Primary Care Ms Pc)
- **Authorized official:** Angie Martinez, SENIOR CREDENTIALING PROFESSIONAL
## Practice location
- **Address:** 1220 E NORTHSIDE DR STE 220, Jackson, MS 39211-5503
- **Phone:** (601) 298-4173 · **Fax:** (877) 866-2356
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 27 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (11), Cardiovascular Disease (Cardiology) (9), Family Practice (6); 4 practice within 10 miles; [full list](https://npiprofile.com/npi/1710693619/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 3, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1710693619) · Data from the CMS NPPES public registry.