1. Home
  2. Directory
  3. Nevada
  4. Las Vegas
  5. Physician Assistant
  6. NPI Profile

SURURAT A COULIBALY PA-C
NPI 1235427816
Physician Assistant - Medical in Las Vegas, NV

Active since July 15, 2011PECOS Enrolled
77.86/100
CMS Quality Rating
630 S RANCHO DR STE E, LAS VEGAS, NV 89106(702) 258-1001(702) 258-3455 Get Directions Write a Review

NPPES record last updated: November 2, 2021. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Nov 2, 2021, Aug 9, 2016 (2 updates tracked since 2016).

About Sururat A Coulibaly Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SURURAT A COULIBALY PA-C (NPI 1235427816) is an individual medical provider in Las Vegas, Nevada, licensed in Nevada (PA1271) and active in the NPI registry since July 2011. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1235427816
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameSURURAT A COULIBALYCredential: PA-C
Location Address630 S RANCHO DR STE ELas Vegas, NV 89106-4849
Mailing Address2285 Corporate Cir, Ste 200Henderson, NV 89074-7759 · (702) 560-2879 · Fax (702) 560-2928
Phone(702) 258-1001
Fax(702) 258-3455
Sole ProprietorNo
Enumeration DateJuly 15, 2011
Last NPPES UpdateNovember 2, 20212 updates tracked since enumeration
NPPES CertifiedNovember 2, 2021
✔ NPI 1235427816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
Licenses✔ Licensed in NV · PA1271✔ Licensed in CA · PA21484
630 S RANCHO DR STE E, Las Vegas, NV 89106
Open in Google Maps ↗

Other Identifiers 2

OtherPA1271NV · Medical License
Medicaid1235427816NV

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sururat A Coulibaly Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

77.86/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality58.05
Promoting Interoperability93
Improvement Activities40
Cost73.99

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

J ROBERT WEST, M.D., INC
Dermatology
630 S RANCHO DR STE E
LAS VEGAS, NV 89106
Clark County (702) 258-1001
JASON STEVENS
Dermatology
630 S RANCHO DR STE E
LAS VEGAS, NV 89106
Clark County (702) 258-1001
ERIKA ARIZABAL VOONG PA-C
Physician Assistant
630 S RANCHO DR STE E
LAS VEGAS, NV 89106
Clark County (702) 258-1001

Frequently 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 Sururat Coulibaly's NPI number?

The NPI number for Sururat Coulibaly is 1235427816. It was assigned to this individual provider in the NPPES registry on July 15, 2011.

Where is Sururat Coulibaly located?

Sururat Coulibaly practices at 630 S Rancho Dr Ste E, Las Vegas, NV 89106. The listed phone number is (702) 258-1001.

What is Sururat Coulibaly's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Sururat Coulibaly enrolled in Medicare?

Yes. Sururat Coulibaly is registered in the Medicare PECOS enrollment system.

What insurance does Sururat Coulibaly accept?

Health plans from Ambetter from Arizona Complete Health list Sururat Coulibaly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sururat Coulibaly was last updated on November 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.