Individual provider Active NPI

Madison N Sistrunk

  • Certified Registered Nurse Anesthetist
  • Jackson, MS
National Provider Identifier
1770055279
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
NOWE-43CHVU Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 984-1000
NPI assigned
Dec 20, 2018
Last updated
Jun 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 897105 MS
Certified Registered Nurse Anesthetist 367500000X NOWE-43CHVU MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500

Other practice location 1

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

Other practice location 2

2500 N State St
Jackson, MS 39216
Phone (601) 984-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190423002307 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 5991047920 Reassigns benefits to 3 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) 815-4775

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

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
897105MSMDRegistered Nurse
NOWE-43CHVUMSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2021 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 14, 2019 Accepting new patients
State of Mississippi-University of Mississippi Medical Center Nurse Anesthetist, Certified Registered CurrentSince Jan 14, 2019 Accepting new patients
State of Mississippi-University of Mississippi Medical Center Nurse Anesthetist, Certified Registered CurrentSince Jan 14, 2019 Accepting new patients

Locations

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

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

2001 Airport Rd N
Ste 308
Jackson, MS 39232
Phone (601) 936-0681

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

2500 N State St
Ste 4200
Jackson, MS 39216

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

Organizations & group practices 5

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": "1545264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1770055279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "960 Avent Dr",
            "address_purpose": "LOCATION",
            "city": "Grenada",
            "state": "MS",
            "postal_code": "389015230",
            "country_code": "US",
            "telephone_number": "662-227-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "39216",
            "country_code": "US",
            "telephone_number": "601-984-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SISTRUNK",
        "first_name": "MADISON",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-20",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "897105",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "NOWE-43CHVU",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.