Individual provider Active NPI

Sara Burwell

  • Family Nurse Practitioner
  • Jackson, MS
National Provider Identifier
1063840148
Registry record updated Sep 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R878011 Issued in MS
Practice address
764 Lakeland Dr
Jackson, MS 39216-4651
Phone
(601) 984-5160
NPI assigned
Oct 28, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R878011 MS Primary

Addresses

Primary practice location

764 Lakeland Dr
Jackson, MS 39216-4651

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5160

Other identifiers 1

IdentifierTypeStateIssuer
04930854MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131228000174 MS Practitioner - Nurse Practitioner 0345477063 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R878011MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Traditions Hospice of Ridgeland, LLC CurrentSince Sep 1, 2022 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Jul 1, 2023 Accepting new patients
Fast Pace Mississippi, PLLC Family CurrentSince Jul 1, 2023 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Dec 4, 2013 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Dec 4, 2013 Accepting new patients
Trustcare Primary Care, LLC Past Accepting new patients

Locations

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

764 Lakeland Dr
Jackson, MS 39216
Phone (601) 982-0611

680 Highway 51
Ste L
Ridgeland, MS 39157
Phone (601) 317-4947

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

8150 N Central Expy
Ste 1800
Dallas, TX 75206
Phone (469) 501-1602

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504828800000",
    "number": "1063840148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5160",
            "fax_number": "601-984-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "764 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164651",
            "telephone_number": "601-984-5160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURWELL",
        "first_name": "SARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-28",
        "last_updated": "2017-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R878011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04930854",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.