OrganizationActive
Centerwell Senior Primary Care Ms PC
NPI 1710693619 · Internal Medicine Physician · Jackson, MS
Provider details
- NPI number
- 1710693619
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Centerwell Senior Primary Care Ms PC
- Organization subpart
- Yes
- Authorized official
- Angie Martinez, Senior Credentialing Professional(407) 447-7120
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Family Medicine Physician207Q00000X
Allopathic & Osteopathic Physicians
- General Practice Physician208D00000X
Allopathic & Osteopathic Physicians
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1220 E Northside Dr Ste 220
Jackson, MS 39211-5503
Phone: (601) 298-4173
Fax: (877) 866-2356
Street-level locationGet directions
Mailing address
6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168
Other names (DBA / former)
- Doing business as
- Centerwell Senior Primary Care-Jackson East
Registry dates
- Enumerated
- 2023-01-25
- Last updated
- 2024-07-03
- Certified
- 2024-07-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.