Shelia A Sancillo Tice, CFNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

R857901 Issued in MS

Practice address

456 W Bankhead St
New Albany, MS 38652-3319

Phone

(662) 534-8780

Fax

(662) 314-8577

NPI assigned

Oct 26, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Shelia A Sancillo Former name

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

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Friendship Medical Clinic LLCGroup PAC ID 0648275024, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DGAACA
• Direct secure messaging: sheliasancillotice@nmhs.medalliesdirect.net

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.

• Friendship Medical Clinic, LLC

  • Nurse Practitioner
  • Ecru, MS
  • NPI 1275586273
  Medicare reassignment Care Compare group NPD
• Premier Radiology, Inc

  • Diagnostic Radiology Physician
  • Tupelo, MS
  • NPI 1083669121
  Medicare reassignment NPD
• Golden Triangle Urgent Care LLC

  • Rural Health Clinic/Center
  • Starkville, MS
  • NPI 1346592045
  Medicare reassignment
• North Mississippi Medical Center

  • General Acute Care Hospital
  • Tupelo, MS
  • NPI 1376969683
  NPD

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480636800000",
    "number": "1255617973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "456 W BANKHEAD ST",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386523319",
            "telephone_number": "662-534-8780",
            "fax_number": "662-314-8577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 W BANKHEAD ST",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386523319",
            "telephone_number": "662-534-8780",
            "fax_number": "662-314-8577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANCILLO TICE",
        "first_name": "SHELIA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "CFNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-26",
        "last_updated": "2016-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MS",
            "license": "R857901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01484713",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELIA",
            "last_name": "SANCILLO",
            "middle_name": "A",
            "prefix": "MRS.",
            "credential": "CFNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Sageberry Psychology, LLC
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• Michael Shane Scott, D.O.
• Ronald B Scott, D.O.
• Thomas Andrew Shands, MD

• Primary Care Nurse Practitioner in New Albany, MS
• Providers in New Albany, MS by specialty
• Primary Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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.