| Oak Street Health Physicians Group Of Mississippi, Llc | |
|
911 Ellis Ave Jackson MS 39209 | |
| (601) 533-7016 | |
| Not Available |
| Full Name | Oak Street Health Physicians Group Of Mississippi, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 911 Ellis Ave, Jackson, Mississippi |
| Authorized Official Name and Position | Griffin Myers (CMO) |
| Authorized Official Contact | 3072642085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oak Street Health Physicians Group Of Mississippi, Llc Po Box 746085 Atlanta GA 30374-6085 Ph: (312) 733-9730 | Oak Street Health Physicians Group Of Mississippi, Llc 911 Ellis Ave Jackson MS 39209 Ph: (601) 533-7016 |
| NPI Number | 1235754995 |
|---|---|
| Provider Enumeration Date | 06/09/2020 |
| Last Update Date | 06/29/2023 |
| Certification Date | 06/29/2023 |
| Medicare PECOS PAC ID | 7012334170 |
|---|---|
| Medicare Enrollment ID | O20200903001414 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235754995 | NPI | - | NPPES |
| Provider Name | Bob Hutchins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033150263 PECOS PAC ID: 8426947706 Enrollment ID: I20040313000771 |
| Provider Name | Barbara Kendrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134152424 PECOS PAC ID: 0244286862 Enrollment ID: I20050328000329 |
| Provider Name | Barbara Tapps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316158900 PECOS PAC ID: 3274694419 Enrollment ID: I20081208000049 |
| Provider Name | Joseph S Hunter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467459149 PECOS PAC ID: 3072682095 Enrollment ID: I20100125000817 |
| Provider Name | Anesha M Cowan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760661821 PECOS PAC ID: 9234219494 Enrollment ID: I20100205000606 |
| Provider Name | April L Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194076836 PECOS PAC ID: 5395982730 Enrollment ID: I20130502000420 |
| Provider Name | Schyler Dewayne Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568855179 PECOS PAC ID: 9537489091 Enrollment ID: I20150522001857 |
| Provider Name | Takita M Murriel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578827739 PECOS PAC ID: 0446560346 Enrollment ID: I20151105000113 |
| Provider Name | Lisa Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063898286 PECOS PAC ID: 4385953256 Enrollment ID: I20160506000406 |
| Provider Name | Esquanickia Fletcher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407390438 PECOS PAC ID: 2668755042 Enrollment ID: I20170209000063 |
| Provider Name | Felix Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982119228 PECOS PAC ID: 4082972112 Enrollment ID: I20171219003448 |
| Provider Name | Chloe Anne Kilman |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1831500818 PECOS PAC ID: 7810211703 Enrollment ID: I20190107002747 |
| Provider Name | Cara Monette Morgan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366477630 PECOS PAC ID: 8820999295 Enrollment ID: I20190416000889 |
| Provider Name | Zipora Martin-brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912471939 PECOS PAC ID: 5092057414 Enrollment ID: I20190503000901 |
| Provider Name | Caroline V Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578020822 PECOS PAC ID: 5092130237 Enrollment ID: I20200804003344 |
| Provider Name | Ali Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710202999 PECOS PAC ID: 7810137718 Enrollment ID: I20201001000846 |
| Provider Name | Thirath Chau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285896720 PECOS PAC ID: 4789854423 Enrollment ID: I20201105001417 |
| Provider Name | Mira Desai |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538559190 PECOS PAC ID: 6800104787 Enrollment ID: I20210426000333 |
| Provider Name | Rachel Sabb |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629321096 PECOS PAC ID: 0547412371 Enrollment ID: I20210427001355 |
| Provider Name | Kelley B Moule |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689984916 PECOS PAC ID: 6800293226 Enrollment ID: I20210927002505 |
| Provider Name | Jana Robinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144358722 PECOS PAC ID: 5395817084 Enrollment ID: I20220121000585 |
| Provider Name | Rochelle Brumfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518415959 PECOS PAC ID: 4486935533 Enrollment ID: I20221210000321 |
| Provider Name | Justin Hunt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326138074 PECOS PAC ID: 6901842228 Enrollment ID: I20230104000382 |
| Provider Name | Kimbell Bingham Waters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316646128 PECOS PAC ID: 6204201262 Enrollment ID: I20230405002651 |
| Provider Name | Tonya Hegwood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023250578 PECOS PAC ID: 5395966006 Enrollment ID: I20231012001039 |
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