Issam D Soussou, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

ME35636 Issued in FL

Practice address

3333 Cattlemen Rd
Suite 206
Sarasota, FL 34232-6056

Phone

(941) 341-0042

Fax

(941) 342-3432

NPI assigned

May 3, 2006

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: surgcrdsm@img.directbygreenway.com

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1104884584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 CATTLEMEN RD",
            "address_2": "SUITE 206",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342326056",
            "telephone_number": "941-341-0042",
            "fax_number": "941-342-3432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 CATTLEMEN RD",
            "address_2": "SUITE 206",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342326056",
            "telephone_number": "941-341-0042",
            "fax_number": "941-342-3432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUSSOU",
        "first_name": "ISSAM",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME35636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38756800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "surgcrdsm@img.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3333 Cattlemen Rd",
            "address_2": "Suite 206",
            "city": "Sarasota",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342326056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Vascular Surgery Physician in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Vascular Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.