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CENTERWELL SENIOR PRIMARY CARE-JACKSON WEST
NPI 1821864174
Internal Medicine in Jackson, MS

Active since November 28, 2023CLIA 25D2307662 · Waiver
4890 HIGHWAY 18 W, JACKSON, MS 39209(407) 447-7120 Get Directions Write a Review

NPPES record last updated: July 3, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Centerwell Senior Primary Care-jackson West NPPES

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

CENTERWELL SENIOR PRIMARY CARE-JACKSON WEST (NPI 1821864174) is a healthcare organization registered as an internal medicine in Jackson, Mississippi and active in the NPI registry since November 2023. The organization holds a CLIA Waiver certificate valid through July 11, 2028 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1821864174
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE MS PC
Location Address4890 HIGHWAY 18 WJackson, MS 39209-9666
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000
Phone(407) 447-7120
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateNovember 28, 2023
Last NPPES UpdateJuly 3, 2024
NPPES CertifiedJuly 3, 2024
✔ NPI 1821864174 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
4890 HIGHWAY 18 W, Jackson, MS 39209
Open in Google Maps ↗

Other Names 1

Doing Business AsCenterwell Senior Primary Care-jackson West

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 25D2307662

Centerwell Senior Primary Care-Jackson West · Jackson, MS
Active · expires Jul 11, 2028
CLIA Number25D2307662
Laboratory TypePhysician Office
Certificate Effective DateJuly 12, 2026
Certificate Expiration DateJuly 11, 2028
Laboratory DirectorDr. Earl K. Magee
Laboratory Phone(601) 301-5385
Laboratory LocationCenterwell Senior Primary Care-Jackson West4890 Highway 18 W Unit A, Jackson, MS 39209
CLIA data matches this NPI record on: Address Name
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.

PATRICK BYNUM MD
Family Medicine
4890 HIGHWAY 18 W
JACKSON, MS 39209
Hinds County (601) 301-5385
MRS. RASHEDA JORDAN WILLIAMS FNP
Nurse Practitioner (Family)
4890 HIGHWAY 18 W
JACKSON, MS 39209
Hinds County (601) 301-5385

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 1821864174. It was assigned to this organization in the NPPES registry on November 28, 2023. The provider is doing business as Centerwell Senior Primary Care-Jackson West.

Where is Centerwell Senior Primary Care Ms PC located?

Centerwell Senior Primary Care Ms PC is located at 4890 Highway 18 W, Jackson, MS 39209. The listed phone number is (407) 447-7120.

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 25D2307662) is associated with this NPI, valid through July 11, 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 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.