Individual provider Active NPI

Joseph Michael Sudderth

  • Registered Nurse
  • Memphis, TN
National Provider Identifier
1619483658
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
217268 Issued in TN
Practice address
6019 Walnut Grove Rd
Memphis, TN 38120-2113
Phone
(901) 226-5000
NPI assigned
Dec 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 901521 MS
Registered Nurse 163W00000X 217268 TN Primary

Addresses

Primary practice location

6019 Walnut Grove Rd
Memphis, TN 38120-2113

Mailing address

34 Franwood CV
Jackson, TN 38301-3314
Phone (601) 500-2188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181025002853 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 5698028371 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Mississippi - University of Mississippi Medical CenterGroup PAC ID 1850293036, shared by 23 NPIs, 956 clinicians

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404

960 Avent Dr
Grenada, MS 38901-5230
Phone (662) 227-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
217268TNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Oct 3, 2018 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi-University of Mississippi Medical Center Nurse Anesthetist, Certified Registered CurrentSince Sep 25, 2018 Accepting new patients
Anesthesia Consultants PA Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2024 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Sep 25, 2018 Accepting new patients
Best Vein Care of Mississippi, LLC CurrentSince Apr 1, 2021 Accepting new patients
Varicosity LLC PastSince Apr 1, 2021 Accepting new patients

Locations

960 Avent Dr
#J
Grenada, MS 38901
Phone (662) 227-6450

1030 River Oaks Dr
Jackson, MS 39232
Phone (601) 376-2165

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

239 Bowling Green Rd
Lexington, MS 39095
Phone (662) 834-1321

204 W Jackson St
#A
Ridgeland, MS 39157
Phone (601) 291-5290

2100 Highway 61 N
Vicksburg, MS 39183
Phone (601) 883-5001

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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": "1514332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1619483658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 FRANWOOD CV",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013314",
            "telephone_number": "601-500-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 WALNUT GROVE RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202113",
            "telephone_number": "901-226-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDDERTH",
        "first_name": "JOSEPH",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-27",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "901521",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "217268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.