Sururat A Coulibaly, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1271 Issued in NV

Practice address

630 S Rancho Dr Ste E
Las Vegas, NV 89106-4849

Phone

(702) 258-1001

Fax

(702) 258-3455

NPI assigned

Jul 15, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NV

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

Merit-based Incentive Payment System (MIPS)

Final score

85.17 of 100Reported as group

Quality

74.51

Promoting interoperability

92

Improvement activities

40

Cost

82.72

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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 and National Provider Directory roles.

• J Robert West, M.D., Inc

  dba Las Vegas Skin and Cancer Clinics

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1295338416
  Medicare reassignment
• Southwest Medical Associates, Inc

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1659346005
  Medicare reassignment
• J Robert West, M.D., Inc

  dba Southern California Dermatology

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1932154788
  NPD
• Intermountain Medical Holdings Nevada Inc

  dba Intermountain Health

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1245997279
  NPD (past)
• Linda L. Johnson MD, LTD

  dba SMA Convenient Care

  • Adult Medicine Physician
  • Henderson, NV
  • NPI 1376838110
  NPD (past)
• Dr. Terry D. Johnson, P.a.

  dba Forestview Primary Care

  • Family Medicine Physician
  • Moncks Corner, SC
  • NPI 1467751495
  NPD (past)

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1235427816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 CORPORATE CIR",
            "address_2": "STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747759",
            "telephone_number": "702-560-2879",
            "fax_number": "702-560-2928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 S RANCHO DR STE E",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064849",
            "telephone_number": "702-258-1001",
            "fax_number": "702-258-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULIBALY",
        "first_name": "SURURAT",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-15",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA21484",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA1271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA1271",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235427816",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Couch Psychiatry, PC
• Billy Couch
• Maria Coughlin
• Samuel Coughtry
• Michelle Couillard
• Erika Liliana Coulson, FNP
• Joseph T Coulson, PA-C
• Lindsay Coulson
• Teresha Coulson
• Marcus Council

• Medical Physician Assistant in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Medical Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.