Individual provider Active NPI

Shaqualar Monique Gandy, NP

  • Family Nurse Practitioner
  • Columbus, MS
National Provider Identifier
1700320660
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
901657 Issued in MS
Practice address
2520 5TH St N
Columbus, MS 39705-2008
Phone
(662) 244-1000
NPI assigned
Dec 12, 2016
Last updated
Jan 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 901657 MS Primary

Addresses

Primary practice location

2520 5TH St N
Columbus, MS 39705-2008

Mailing address

2520 5TH St N
Columbus, MS 39705-2008
Phone (662) 244-2150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170215001348 MS Practitioner - Nurse Practitioner 9133402282 Reassigns benefits to 3 organizations
I20170601001572 TN Practitioner - Nurse Practitioner 9133402282 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Emergency Services of MississippiGroup PAC ID 9739188046, 12 clinicians
Weekends Plus Urgent Care LLCGroup PAC ID 6608151683, 6 clinicians

Practice addresses (Care Compare)

2520 5TH St N
Columbus, MS 39705-2008
Phone (662) 244-1000

3189 High Way 45
Suite H
Columbus, MS 39705-1251
Phone (662) 570-4507

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
901657MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Dec 12, 2017 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Dec 12, 2017 Accepting new patients
Fast Pace Mississippi, PLLC Family CurrentSince Jan 1, 2018 Accepting new patients
Carr PLLC CurrentSince Apr 1, 2017 Accepting new patients
Weekends Plus Urgent Care LLC CurrentSince Jan 5, 2020 Accepting new patients
United Emergency Services of Mississippi CurrentSince Jan 4, 2017 Accepting new patients
Fast Pace Mississippi, PLLC CurrentSince Jan 1, 2018 Accepting new patients
T M Carr MD PC CurrentSince Apr 1, 2017 Accepting new patients

Locations

2520 5th St N
Columbus, MS 39705
Phone (662) 224-1000

517 City Ave S
Ripley, MS 38663
Phone (662) 587-8206

1300 Wesley Dr
Memphis, TN 38116
Phone (901) 516-3700

3960 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5200

7691 Poplar Ave
Memphis, TN 38138
Phone (901) 516-1290

1021 Mulberry Ave
Selmer, TN 38375
Phone (731) 645-7767

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16677/brand/1/csg/1/fhir/r4

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1700320660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052008",
            "telephone_number": "662-244-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052008",
            "telephone_number": "662-244-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDY",
        "first_name": "SHAQUALAR",
        "middle_name": "MONIQUE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-12",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "901657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, MS

Sources for this page

Verify at the official NPI Registry.