Spencer K Sullivan, MD

Primary specialty

Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X

License

23304 Issued in MS

Practice address

7730 Old Canton Rd BLDG B
Madison, MS 39110-9299

Phone

(601) 499-0935

Fax

(601) 499-0936

NPI assigned

May 2, 2007

Last updated

Apr 14, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Medical Foundation of Central Mississippi, Inc.

  dba Baptist Medical Clinics

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1992774814
  Medicare reassignment NPD
• Mississippi Center for Advanced Medicine PC

  dba Mississippi Center for Advanced Medicine

  • Community/Retail Pharmacy
  • Madison, MS
  • NPI 1740636786
  Authorized official Same address or phone
• Mississippi Center for Advanced Medicine, PC

  • Durable Medical Equipment & Medical Supplies
  • Madison, MS
  • NPI 1427787845
  Authorized official Same address or phone
• Mississippi Center for Advanced Medicine, PC

  • Specialist
  • Madison, MS
  • NPI 1790227627
  Authorized official Same address or phone
• Mississippi Center for Advanced Medicine, PC

  dba Louisiana Center for Advanced Medicine

  • Specialist
  • Slidell, LA
  • NPI 1508426917
  Authorized official Same address or phone
• Mississippi Center for Advanced Medicine, PC

  dba Louisiana Center for Advanced Medicine

  • Community/Retail Pharmacy
  • Slidell, LA
  • NPI 1548720527
  Authorized official Same address or phone
• Medical Foundation of Central Ms

  dba Baptist Medical Clinic-Brandon

  • Family Medicine Physician
  • Brandon, MS
  • NPI 1114264264
  NPD

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1073735114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD STE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106115",
            "telephone_number": "601-499-0935",
            "fax_number": "601-499-0936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7730 OLD CANTON RD BLDG B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391109299",
            "telephone_number": "601-499-0935",
            "fax_number": "601-499-0936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SPENCER",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "MS",
            "license": "23304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01212067",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Chandler Strain, PHARM D
• George Elder Stuart Jr., PT, DPT
• Miranda Street Sudduth, PA-C
• David M Sullivan, M.D.
• Sabra Sullivan, M.D., PHD.
• Sonya Sebren Summerlin
• Summit Collaborative Care
• Summit Medical Solutions
• Kelsey Sumrall, PT
• Superior Soles

• Pediatric Hematology & Oncology Physician in Madison, MS
• Providers in Madison, MS by specialty
• Pediatric Hematology & Oncology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.