NPIMap

Individual provider Active NPI

Mtanius A Sultani, MD

  • Hematology & Oncology Physician
  • Clarksdale, MS
National Provider Identifier
1972577930
Registry record updated May 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
15212 Issued in MS
Practice address
581 Medical Dr
Clarksdale, MS 38614
Phone
(662) 627-7163
Fax
(662) 627-7150
NPI assigned
Feb 15, 2006
Last updated
May 5, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 15212 MS Primary

Addresses

Primary practice location

581 Medical Dr
Clarksdale, MS 38614

Mailing address

PO Box 1887
Clarksdale, MS 38614
Phone (662) 627-7163

Other identifiers 2

IdentifierTypeStateIssuer
00117894MedicaidMS
135110001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111213000350 MS Practitioner - Hematology/OncologyPractitioner - Internal Medicine 3779569934 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delta Health SystemGroup PAC ID 0042208787, 2 clinicians

Practice addresses (Care Compare)

1400 E Union St
Delta Health the Med Center
Greenville, MS 38703-3246
Phone (662) 378-3783

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Delta Health System Current Accepting new patients
Delta Health System CurrentSince Sep 29, 2020 Accepting new patients
Delta Health System CurrentSince Sep 29, 2020 Accepting new patients
Delta Medical Group CurrentSince Jun 18, 2020 Accepting new patients
Delta Health System Past Accepting new patients
Delta Physician Practices Past Accepting new patients

Locations

581 Medical Dr
Clarksdale, MS 38614
Phone (662) 624-8731

1400 E Union St
Greenville, MS 38703
Phone (601) 427-0422

1514 E Union St
Greenville, MS 38703
Phone (662) 332-6150

1693 Fairgrounds Rd
Greenville, MS 38703
Phone (662) 378-3783

Interoperability endpoints

  • Direct secure messaging: sultani_mtanius_md@yourcarecommunity.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399248000000",
    "number": "1972577930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1887",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "38614",
            "telephone_number": "662-627-7163",
            "fax_number": "662-627-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "581 MEDICAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "38614",
            "telephone_number": "662-627-7163",
            "fax_number": "662-627-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULTANI",
        "first_name": "MTANIUS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2014-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MS",
            "license": "15212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117894",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135110001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

Verify at the official NPI Registry.