Sally Sullivan, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R892793 Issued in MS

Practice address

971 Lakeland Dr
Jackson, MS 39216-4643

Phone

(334) 279-1450

Fax

(334) 395-4110

NPI assigned

May 24, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gac Anesthesia LLCGroup PAC ID 4587902663, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• Gac Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Columbus, MS
  • NPI 1386112639

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Physicians Anesthesia Group, P.a.

  • Anesthesiology Physician
  • Jackson, MS
  • NPI 1407890783
  Medicare reassignment NPD
• Lifelinc Anesthesia, PLLC

  • Anesthesiology Physician
  • Memphis, TN
  • NPI 1801021464

  MS, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464048000000",
    "number": "1609223205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4608",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392964608",
            "telephone_number": "334-279-1450",
            "fax_number": "334-395-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164643",
            "telephone_number": "334-279-1450",
            "fax_number": "334-395-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "SALLY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-24",
        "last_updated": "2016-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R892793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Simmons Sullivan, MD
• Lisa Myers Sullivan, MD
• Madison Brooke Sullivan
• Mark Sullivan
• Molly Sullivan
• Bertha Siedah Sullivn, RN
• Ralph E Sulser, M.D.
• Aqfa Sultana
• Dominique Shunta Sulton
• Michal Sumerall, RN

• Certified Registered Nurse Anesthetist in Jackson, MS
• Providers in Jackson, MS by specialty
• Certified Registered Nurse Anesthetist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.