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PRENTISS PRIMARY CARE, P.A.
NPI 1902129455
Internal Medicine in Prentiss, MS

Active since March 11, 2010CLIA 25D1007211 · Waiver
959 HWY 42, PRENTISS, MS 39474(601) 792-3200(601) 792-3299 Get Directions Write a Review

NPPES record last updated: March 11, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Prentiss Primary Care, P.a. NPPES

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

PRENTISS PRIMARY CARE, P.A. (NPI 1902129455) is a healthcare organization registered as an internal medicine in Prentiss, Mississippi and active in the NPI registry since March 2010. The organization holds a CLIA Waiver certificate valid through December 10, 2026 and lists Jaishankar Jagadeesan, President, as its authorized official.

NPPES Registry Identity

NPI1902129455
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePRENTISS PRIMARY CARE, P.A.
Location Address959 HWY 42Prentiss, MS 39474-1373
Mailing AddressPo Box 1373Prentiss, MS 39474-1373 · (601) 792-3200 · Fax (601) 792-3299
Phone(601) 792-3200
Fax(601) 792-3299
Organization SubpartNo
Authorized OfficialJaishankar JagadeesanPresident · (601) 792-3200
Enumeration DateMarch 11, 2010
✔ NPI 1902129455 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in MS · 15442
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.
959 HWY 42, Prentiss, MS 39474
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Other Identifiers 2

Medicaid00118344MS
Medicaid09016230MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

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 25D1007211

Prentiss Primary Care PA · Prentiss, MS
Active · expires Dec 10, 2026
CLIA Number25D1007211
Laboratory TypePhysician Office
Certificate Effective DateDecember 11, 2024
Certificate Expiration DateDecember 10, 2026
Laboratory DirectorDr. Jaishankar Jagadeesan
Laboratory Phone(601) 792-3200
Laboratory LocationPrentiss Primary Care PA1529 Columbia Avenue, Prentiss, MS 39474
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Prentiss Primary Care, P.A.'s NPI number?

The NPI number for Prentiss Primary Care, P.A. is 1902129455. It was assigned to this organization in the NPPES registry on March 11, 2010.

Where is Prentiss Primary Care, P.A. located?

Prentiss Primary Care, P.A. is located at 959 Hwy 42, Prentiss, MS 39474. The listed phone number is (601) 792-3200.

What is Prentiss Primary Care, P.A.'s specialty?

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

Does Prentiss Primary Care, P.A. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D1007211) is associated with this NPI, valid through December 10, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Prentiss Primary Care, P.A. accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Prentiss Primary Care, P.A. 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 Prentiss Primary Care, P.A. was last updated on March 11, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.