SULLIVAN FAMILY MEDICINE CLINIC
NPI 1215933346
Clinic/Center in Jackson, MS
About Sullivan Family Medicine Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SULLIVAN FAMILY MEDICINE CLINIC (NPI 1215933346) is a healthcare organization registered as a clinic/center in Jackson, Mississippi and active in the NPI registry since June 2005. The organization holds a CLIA Waiver certificate valid through April 20, 2027 and lists Hursie J Davis-sullivan, Owner And President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 5
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Sullivan Family Medicine Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Sullivan Family Medicine Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 25D1011770
Sullivan Family Medicine Clinic · Jackson, MSFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Heeers, PA's NPI number?
The NPI number for Heeers, PA is 1215933346. It was assigned to this organization in the NPPES registry on June 23, 2005. The provider is doing business as Sullivan Family Medicine Clinic.
Where is Heeers, PA located?
Heeers, PA is located at 1814 Hospital Dr, Jackson, MS 39204. The listed phone number is (601) 373-2940.
What is Heeers, PA's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Heeers, PA enrolled in Medicare?
Yes. Heeers, PA is registered in the Medicare PECOS enrollment system.
When is Heeers, PA's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Mississippi, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Heeers, PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Heeers, PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Heeers, PA hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D1011770) is associated with this NPI, valid through April 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Heeers, PA was last updated on November 9, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Sullivan Family Medicine Clinic · NPI 1215933346
Clinic/Center organization in Jackson, Mississippi. Organization record, active in the CMS NPPES registry since June 23, 2005.
## Identity
- **NPI:** 1215933346 (Entity type: Organization)
- **Enumerated:** June 23, 2005
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Legal business name:** Heeers, Pa
- **Organization subpart:** No
- **Authorized official:** Hursie Davis-Sullivan, OWNER AND PRESIDENT
## Practice location
- **Address:** 1814 HOSPITAL DR, Jackson, MS 39204-3410
- **Phone:** (601) 373-2940 · **Fax:** (601) 373-2720
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Mississippi, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 9, 2010
- **Other identifiers:** Medicare ID-Type Unspecified C02914 (MS); Medicaid 00112110 (MS); Medicaid 08236531 (MS); and 2 more
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1215933346) · Data from the CMS NPPES public registry.