NPIMap

Individual provider Active NPI

Samuel Keith Suttle, M.D.

  • Family Medicine Physician
  • Louisville, MS
National Provider Identifier
1497705453
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
08435 Issued in MS
Practice address
14724 Highway 15 N
Louisville, MS 39339-6318
Phone
(662) 773-7500
NPI assigned
May 11, 2006
Last updated
Mar 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 08435 MS Primary

Addresses

Primary practice location

14724 Highway 15 N
Louisville, MS 39339-6318

Mailing address

8613 Ms Highway 12
Ackerman, MS 39735-8917
Phone (662) 285-9460

Other identifiers 1

IdentifierTypeStateIssuer
00119309MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091207000030 MS Practitioner - Family Practice 8022012475 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Choctaw Regional Medical CenterGroup PAC ID 2567682206, 39 clinicians

Practice addresses (Care Compare)

14724 Hwy 15 N
Louisville, MS 39339-6318
Phone (662) 285-9460

8613 Ms Hwy 12
Ackerman, MS 39735-8917
Phone (662) 285-9460

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.39 of 100Reported as group
Quality
65.98
Improvement activities
40
Cost
74.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Choctaw Regional Medical Center Family Medicine CurrentSince May 1, 2015 Accepting new patients
Winston County Medical Foundation CurrentSince Jan 1, 2015 Accepting new patients
Choctaw Regional Medical Center Past Accepting new patients
Winston County Medical Foundation Past Accepting new patients

Locations

8613 MS Highway 12
Ackerman, MS 39735
Phone (662) 285-4400

14724 Highway 15 N
Louisville, MS 39339
Phone (662) 773-7500

17550 E Main St
Louisville, MS 39339
Phone (662) 446-1072

Interoperability endpoints

  • Direct secure messaging: samuel.suttle.1@15070.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1497705453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8613 MS HIGHWAY 12",
            "city": "ACKERMAN",
            "state": "MS",
            "postal_code": "397358917",
            "telephone_number": "662-285-9460",
            "fax_number": "662-285-9324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14724 HIGHWAY 15 N",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393396318",
            "telephone_number": "662-773-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTLE",
        "first_name": "SAMUEL",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "08435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119309",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, MS

Sources for this page

Verify at the official NPI Registry.