Aqfa Sultana

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

21234 Issued in MS

Practice address

3502 W Northside Dr
Jackson, MS 39213-4454

Phone

(601) 364-5142

Fax

(601) 364-5159

NPI assigned

Jul 25, 2007

Last updated

Sep 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Mississippi Civic Improvement Association, IncGroup PAC ID 4183533235, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sta Home Health Agency of Jackson, Inc. Dba Accentcare Home Health of Jackson Home health agency, Clinton, MS, CCN 257102

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aqfa.sultana@jhchc.eclinicaldirectplus.com

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.

• Central Mississippi Civic Improvement Association, Inc

  dba Jackson Hinds Comprehensiv Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1134151442
  Medicare reassignment Care Compare group NPD
• Central Mississippi Civic Improvement Association, Inc.

  dba Jackson Hinds Comprehensive Health Center Unit 7

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1215744396
  NPD
• Central Mississippi Civic Improvement Association, Inc

  dba Jackson Hinds Comprehensive Health Center

  • Federally Qualified Health Center (FQHC)
  • Vicksburg, MS
  • NPI 1932145539
  NPD (past)

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

• Sta-Home Health Agency of Jackson, Inc.

  dba AccentCare Home Health of Jackson

  • Home Health Agency
  • Clinton, MS
  • NPI 1356482749
  Care Compare affiliation

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1700076940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454",
            "telephone_number": "601-364-5142",
            "fax_number": "601-364-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 W NORTHSIDE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134454",
            "telephone_number": "601-364-5142",
            "fax_number": "601-364-5159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULTANA",
        "first_name": "AQFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-25",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MS",
            "license": "21234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09964",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07331261",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Sullivan
• Molly Sullivan
• Sally Sullivan, CRNA
• Bertha Siedah Sullivn, RN
• Ralph E Sulser, M.D.
• Dominique Shunta Sulton
• Michal Sumerall, RN
• Donna Summers, LMT
• Frankie Summers Jr.
• Mark William Summers, MD

• Adult Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Adult Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; 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.