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Cristina Sullivan Leis, PA-C

Individual provider Active NPI Surgical Physician Assistant · Flowood, MS

NPI 1548858749 · NPPES record last updated Dec 13, 2022

Key facts

NPI
1548858749
Entity type
Individual (NPI type 1)
Primary specialty
Surgical Physician Assistant 363AS0400X
License
PA00516 (MS)
Practice address
104 Burney Dr
Flowood, MS 39232-6621
Phone
(601) 987-8200
NPI assigned
Jan 4, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 26

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.

View all 26

Hospital & facility affiliations 1

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

Medicare Care Compare profile

Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell Clinic, PC (229 clinicians)

Practice addresses (Care Compare)

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

2608 S Lamar Blvd
Suite 102
Oxford, MS 38655-5243
Phone (901) 759-3100

7545 Airways Blvd
Southaven, MS 38671-5806
Phone (901) 759-3196

Hospital & facility affiliations

  • Baptist Memorial Hospital North Ms Hospital · Oxford, MS · CCN 250034

Merit-based Incentive Payment System (MIPS)

Final score
75.09 of 100 (group)
Quality
50.47
Promoting interoperability
99
Improvement activities
40
Cost
67.33

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS, TN
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20210422002672 MS Practitioner - Physician Assistant 0244648673 Reassigns benefits to 1 organization
I20230629002433 TN Practitioner - Physician Assistant 0244648673 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00516MSMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Clinic PC Current
since Apr 17, 2023		 Accepting new patients
Campbell Clinic, PC Physician Assistant Current
since Apr 17, 2023		 Accepting new patients
CC Bpci PLC Past Accepting new patients
Campbell Clinic Past Accepting new patients

Locations

6760 Goodman Rd
Ste 110
Olive Branch, MS 38654

2608 S Lamar Blvd
Ste 102
Oxford, MS 38655

7545 Airways Blvd
Southaven, MS 38671
Phone (901) 759-3196

1458 W Poplar Ave
Ste 100
Collierville, TN 38017
Phone (901) 759-5491

1900 W Poplar Ave
Collierville, TN 38017
Phone (901) 759-5491

7887 Wolf River Blvd
Memphis, TN 38138
Phone (901) 759-3180

1211 Union Ave
Ste 500
Memphis, TN 38104
Phone (901) 759-3275

1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1366/brand/1/csg/1/fhir/r4
  • Direct secure messaging: cristina.leis.1@1366.direct.athenahealth.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00516 MS
Surgical Physician Assistant 363AS0400X PA00516 MS Yes

Addresses

Primary practice location

104 Burney Dr
Flowood, MS 39232-6621

Mailing address

104 Burney Dr
Flowood, MS 39232-6621
Phone (601) 506-2297

Other practice location 1

102 Lexington Dr Ste 100
Madison, MS 39110-6952
Phone (601) 973-1688

Other providers in Flowood, MS

All providers in Flowood, MS · Surgical Physician Assistant in Mississippi

Sources for this page

Verify at the official NPI Registry.