NPIMap

Organization Active NPI

Mississippi Center for Advanced Medicine, PC

  • Specialist
  • Madison, MS
National Provider Identifier
1790227627
Registry record updated Dec 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
23304 Issued in MS
Legal business name
MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC
Practice address
7731 Old Canton Rd
Suite B
Madison, MS 39110-6114
Phone
(601) 499-0935
Fax
(601) 499-0936
NPI assigned
Nov 9, 2016
Last updated
Dec 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2016

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

Authorized official

Name
Dr. Spencer K Sullivan, M.D.NPI 1073735114
Title
President/Ceo
Phone
(601) 499-0935

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 23304 MS Primary

Addresses

Primary practice location

7731 Old Canton Rd
Suite B
Madison, MS 39110-6114

Mailing address

7731 Old Canton Rd
Suite B
Madison, MS 39110-6114
Phone (601) 499-0935

Other identifiers 1

IdentifierTypeStateIssuer
01212067MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160707000847 MS Part B Supplier - Clinic/Group Practice 1951693282 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
Practice locations: Madison, MS; Tupelo, MS; Southaven, MS; Ruleville, MS; Oxford, MS; McComb, MS; Jackson, MS; Hattiesburg, MS…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

200 Park Creek Dr
Columbus, MS 39705
Phone (662) 327-8410

1200 N State St
Ste 180
Jackson, MS 39202
Phone (601) 414-0484

7731 Old Canton Rd
Ste A
Madison, MS 39110
Phone (601) 853-3565

309 Llewellyn Ave
McComb, MS 39648
Phone (601) 354-4836

4428 S Eason Blvd
Ste B
Tupelo, MS 38801

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482278400000",
    "number": "1790227627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD",
            "address_2": "SUITE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106114",
            "telephone_number": "601-499-0935",
            "fax_number": "601-499-0936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD",
            "address_2": "SUITE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106114",
            "telephone_number": "601-499-0935",
            "fax_number": "601-499-0936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI CENTER FOR ADVANCED MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-09",
        "last_updated": "2016-12-21",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "601-499-0935",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MS",
            "license": "23304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01212067",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.